The primary health care non-team?BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6966.1387 (Published 26 November 1994) Cite this as: BMJ 1994;309:1387
- Pauline Pearson,
- Kevin Jones
Small groups set up to perform specific tasks are preferable to teams with nebulous aims
Is the primary health care team a myth? Teams can be defined in a variety of ways—whether as “beasts of burden yoked together” (Oxford English Dictionary) or “a small group of people who relate to each other to contribute to a common goal.”1 Successive governments and professional organisations have advocated the creation and maintenance of “the primary health care team.”2 3 4 5 Teamwork in primary care, it is suggested, is the way forward, and by implication, the way to achieve high quality care for patients. But what is the evidence for this and what are we aspiring to? Do we have teams or non-teams?
The literature yields few empirical data on the topic. Work in Newcastle upon Tyne indicated some consensus among practitioners regarding core participants, who generally include medical, nursing, and reception staff.6 But much less agreement exists regarding membership of the extended team—members are drawn in as necessity dictates. Some of the variation in composition may be attributable to differing definitions of the team, depending on whether shared function, employment status, or clinical practice is its defining characteristic.
Gregson and her colleagues looked at the collaboration of doctor-nurse pairs and concluded that factors such as a shared base (for example, in a health centre) and stable attachment were important in encouraging such collaboration.7 More recently the same unit has described some of the misunderstandings and mismatches of perception among members in 20 practices in Northumberland.8 This confusion reflects the experience of many practitioners for whom teamwork …