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The loss of multidisciplinary primary healthcare teams is bad for patient care

BMJ 2013; 347 doi: (Published 09 September 2013) Cite this as: BMJ 2013;347:f5450
  1. Richard Watton, general practitioner, The White House Surgery, 1 Fairfax Rise, Sheffield S2 1SL, UK
  1. rjwatton{at}

General practice should be the hub of healthcare, so why are general practice based teams being dismantled, asks Richard Watton

Practice based multidisciplinary primary healthcare teams are being dismantled and replaced with geographically based teams that do not contain general practitioners. Let our experience be a wake up call: there may be unintended consequences. Remember out of hours care? No one intended to make this worse, but a shambles was created simply by taking frontline responsibility from general practitioners.

Thirty years ago we had a social worker, health visitor, physiotherapist, community psychiatric nurse, midwife, and a small team of district nurses all attached to the practice. We were a working team.1 2 We discussed patients informally every day, and we met formally once a week.

We have lost these workers one by one. The social worker was removed when social workers ceased to be generic. She was replaced with a flow diagram showing us how effective the lines of communication would be between us and social services. That was the start of our interaction with …

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