Teamwork in rural practice

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At the WONCA Santiago conference, we held a small workshop looking at some of the issues around team working, particularly in rural primary care. This built on the workshop jointly hosted by the UK RCGP( the Royal College of General Practitioners) and the RCN (Royal College of Nursing) in London in January 2003.

We had descriptions of different team working arrangements in several different countries, including, the UK, Sweden, Zambia, Israel, New Zealand and Australia, and we were most grateful for these contributions.

Several themes emerge:

• There are big differences in the way we all practice and work together.
  
• There are concerns about the legal basis for some of the work, traditionally undertaken by doctors but now delegated to nurses. Nurses are sometimes doing work now that is not within their job descriptions; although there seems to be little evidence that this is slowing the development of better team-working.
  
• There are differences in the way in which nurses are trained to manage their "extended" role.
  
• It takes a considerable time to learn how to cope with uncertainty in diagnosis, and accept the associated responsibility.
  
• There are major differences in the levels of healthcare personnel in different countries.
  
• There are major differences in patients' expectations of having a home visit. Involving patients more in their care and the organisation of care is better developed in some countries than others.
  
• There are differences in the amount of responsibility which the nurses have in different systems
  
• There are problems with different team members having different management structures, and being accountable to different people: any management structure must facilitate good communicate between all healthcare professionals.
  
• All team members need adequate time and support to be able to study.

• There seem to be no pre-defined boundaries for the roles of doctors and nurses, and this needs to be negotiated and agreed locally.
  
• When different professionals take responsibility for particular tasks, they should perform to the same level and be assessed similarly.
  
• Communication is very important, and lack of effective communication leads to extra work, duplication of effort and confusion for the patients.

It seems that we can all learn a great deal from each other. If we had more information about how our different health systems function, and how we share our work out, we would be better able to define best practice and seek to emulate it. There seems a golden opportunity for useful reports and studies describing how team-working is happening in all countries across the world, and thus for publicising best practice.

Iain Mungall
Glamorgan, Wales

Joyce Kenkre
Northumberland, England