Models of multidisciplinary working: international review

Recommendations

General Recommendations

• The review acts as a reminder that rural health delivery challenges are evident in all countries with a rural population. Some issues are the same, some are different, but nowhere are the issues entirely resolved. This is a key message to make to health professionals, policy makers, politicians, media and the wider public in Scotland.
• Further international proofing of policy would be useful for Scotland and enhance its reputation as a forward looking, modern jurisdiction. The methods used here could be used for other issues in health and beyond, for an international perspective on policy development.
• Most health systems examined have more than one contractual arrangement for delivery of primary care services; following the notion that one size does not fit all, and often there is variation in contract between rural and urban areas (the extreme case is Norway). It would be valuable to test the flexibility of the Scottish general practice contract or consider the potential for different contracts, to enable different models of delivery tailored to rural Scotland. This could include the possibility of community owned practices.
• Ensure Scottish policy is fully aligned with international health workforce strategy, and rural health strategies, to ensure excellence and innovation. There may be opportunities for further engagement with international bodies at government, academic and professional levels. There are also opportunities for policy makers and health service staff to link to their peers in other jurisdictions.
• Find ways to ensure that multi-disciplinary team members, including GPs, are acting at the higher limit of their competencies rather than undertaking tasks that could be delegated. This change, when done correctly, and with communities on board, can lead to more effective care, more manageable workload, more challenging caseloads, and less shortages of staff.

Specific Recommendations

• Test the New Zealand Population-based Funding Formula, and see if it any elements of it improve resource allocation modelling in Scotland.
• Examine in more detail how New Zealand primary care managed to get past the "tipping point" for the introduction of Nurse Practitioners into health care delivery.
• Undertake detailed analysis of the strategy, protocol and recruitment from Northern Territory, Australia, where progress in rural health delivery has been made, and a model which may have specific learning points is in place.
• Investigate further detail the community retention model from Victoria, Australia
• Investigate in further detail the Finnish Self-Referral Model, which is run from Social and Healthcare Stations, and has spread to serve the majority of the Finnish population
• Primary care networks seem to be common and effective in many rural areas, and Scotland could examine the various models to inform policy development on clusters.
• Investigate the extent of multidisciplinary learning in British Columbia.