NHS frontline needs in-house physios working in multidisciplinary teams, says King’s Fund

^{King’s Fund: trusts should be specifying the composition of teams and promoting interdisciplinary collaboration}

The document, Organising care at the NHS frontline, was published by the health think tank on 3 May. It says clinical leaders have a key responsibility to connect clinical teams with trust leaders. They must work jointly to develop more effective ways of organising care on hospital wards and clinics.

The report includes contributions from a patient, manager, consultant, student and a nurse. One of these is Matthew Lewis, a consultant in general medicine and gastroenterology at Sandwell and West Birmingham Hospitals NHS Trust.

Ideally, he says, a ward round would bring together the consultant, junior doctors, physiotherapist, senior nurse, pharmacist and others for several hours each week.

But he acknowledges this is difficult to achieve because most wards are not staffed to this level. Also, such a sustained period of coordinated activity would tie staff to the ward round when they could be seeing patients independently.

A valuable learning experience

Another contributor, medical student Harrison Carter, talks about observing how different members of the team will care, cure and prevent disease and disability in different ways.

‘Some of the most valuable learning I have acquired has been from physiotherapists, nurses, midwives, speech and language and occupational therapists,’ he says.

A first exposure to the multidisciplinary team could come at medical school, he argues.

‘Making this common practice would establish multidisciplinary working for the most junior members of the team once they have qualified,’ says Mr Harrison.

Filling Vacancies

Increases in the numbers of doctors, allied health professionals and other staff in hospitals have helped the NHS meet rising demand, the King’s Fund says. But there are now difficulties in filling vacancies.

It found that the use of agency staff to address workforce shortages has affected team working and continuity of care. Increasing reliance on agency staff and gaps in staff rotas accentuate the difficulties in providing the effective continuity and teamwork on which good care in today’s NHS depends.

It cites an example given by Michael Wise, a specialist in both oral surgery and restorative dentistry, who in 2009 contracted sepsis with near-fatal consequences and contributed to the report as a patient. He describes his experience of agency staff who were not aware of the requirements of a transplant patient.

Interdisciplinary collaboration

Offering solutions to these issues, the report advises that trusts could reduce variations in care for acutely ill patients by standardising the organisation of care on hospital wards. This may include specifying the composition of teams and interdisciplinary collaboration.

It calls for trust leaders to support clinical teams and managers by providing the training, resources and time they need to improve care. In addition, they should ‘visibly attend to how care is organised at the frontline and signal that this is an organisational priority’.