This site is intended for health professionals only

Multiprofessional learning: is it the way forward?

Kate Howie
RGN BNS(Hons) CHCN CPT
Practice Nurse
Alton
Hampshire
Practice Nurse Trainer
North Hants Primary Care Trust
Executive Committee Member
North Hants Primary Care Trust

For those working within primary care, the concept of a primary healthcare team working with the same goal of identifying needs and improving health for the patients and the community is viewed as an overriding aim. In practice, however, this is not always the case. There are too many health professionals pulling different ways, often for the same thing. Personal experience, through closer involvement with the primary care trusts (PCTs) and the development of clinical governance, has shown that, by learning together, health professionals tend to develop a greater respect for each other and improved understanding of each other's roles within the wider area of primary care.
Several recent multidisciplinary workshops within the area have been extremely successful in their aim to bring community health­care professionals together to focus on specific issues and look at ways of working cooperatively to improve care. This has also proved a useful opportunity for professionals to learn more about the way each other works and the different skills and knowledge that they can bring to the primary care agenda.
 
Changing agenda
Primary healthcare encompasses medical care, health promotion and illness prevention strategies, and there is now a greater drive towards integration and improved teamworking between all community healthcare professionals to improve patient care and effectively address the community's needs.
The 1996 White Paper Primary Care: Delivering the Future(1) states that achieving quality in primary care will require interprofessional working. It advocates that a greater proportion of all education and training should be multidisciplinary, with specific training to promote teamwork.(1) Education plays a significant role in forming attitudes, and failure to collaborate effectively results from different training approaches, structures and ideologies.(1)
If there was a gradual introduction of continuing professional development and education for all community healthcare professionals, it is believed that shared learning would bring a greater degree of collaboration, cooperation and multidisciplinary working that would benefit all.

Interprofessional learning
Interprofessional learning has been described as different professionals coming together to ensure the process of increasing quality and improving services provided. Professionals bring with them their own different perspectives to a shared topic, and as a result gain a wider view of it than an individual or a single professional group could achieve.
If all community healthcare professionals had the opportunity to learn together in a variety of settings, for example through formal multidisciplinary study sessions, or by critical incident analysis and reflection within the primary healthcare team (PHCT), then it is hoped that communication would significantly improve between them. It would also serve to promote a better understanding and raise awareness of the roles and responsibilities of the various members of the PHCT.
Perceived benefits for multiprofessional learning include improvements to patient care and increased patient satisfaction. It also enhances the roles and perceptions of other professions, promoting teamwork and cooperation between professionals, contributing to the learner's knowledge and enhancing the development of clinical skills.
A further benefit of this would be an increasing collaboration and integration between healthcare professionals, both in primary and secondary care, which in turn should lead to an overall improvement in the quality and range of services offered. Awareness of the potential barriers to multidisciplinary learning would also enable professionals to be flexible in their approach and to work towards creating an environment that would facilitate effective collaboration.
However, if education were to be truly multidisciplinary then it would have to start from the beginning of training. There needs to be a common core curriculum in health promotion and disease prevention and management for all healthcare professionals. Scepticism, however, exists among the teachers of the different professional groups regarding the use of shared learning to facilitate changes in professional boundaries and functions(2) and the contribution to improvements in professional satisfaction or the quality of service provision.
Continual professional development also needs to be encouraged to ensure that high standards and quality of care are maintained and that professionals keep up to date with the latest developments within practice.
Opportunistic and experiential learning within practice is extremely valuable for all healthcare professionals, and within a PHCT it can be a useful tool to develop better multiprofessional working.

Teamworking
There is a greater emphasis than ever before on the whole culture and development of effective teamworking, and an appreciation of each other's values is a basic motivating factor in team behaviour and is essential for morale.(3) Within primary care, teamworking is seen as a major factor in the promotion and delivery of effective care for patients.
Multidisciplinary teams can provide effective services when they have responsibility for creating policies, and the issues of leadership, roles and responsibility have been planned, agreed and continually managed. Multiprofessionals who work together across boundaries to focus on a wide variety of services could work more effectively if they had a better understanding of each other's roles and could ensure that the most appropriate professional took responsibility for specific care within the team.
The ability to work with other professionals and to develop an understanding of other jobs and responsibilities is a skill that can be learnt, provided that individuals are prepared to make an effort. Several benefits of this would include better care for the patients, greater job satisfaction for the professionals, higher team morale and a greater sense of achievement.
There also has to be mutual recognition between the various team members of the differing skills, expertise and knowledge that each individual member will bring with them, and as the demand for healthcare continues to grow, any role changes must be planned and developed, with teams needing to be managed as "cohesive units".(4) Integration is an important factor in enabling primary care professionals to work closely, to identify areas of overlap, and to identify the key skills required to deliver care.(5) The Personal Medical Services Pilots(6) are beginning to open the way for nurse/GP partnerships, and current trends indicate that the primary care skillmix for the future will involve all practitioners.
There are many barriers to increasing collaboration and integration that are often based upon long-held beliefs, traditions and cultures within individual professional organisations. The NHS is characterised by stereotypical clinical roles that have evolved over time, and as the NHS faces radical change there are still many individuals and professional groups that cling to their historical precedents and are reluctant to let go of their traditional power bases.(7) However, the growth of the role, function and number of practice nurses, for example, has changed ways of working within many general practices.(5)
There is also growing evidence that patients do not benefit from large, fragmented networks in which professional tribalism impedes collaboration.(8) One could argue that it is the doctors who fear this blurring of boundaries the most, as primary care continues to develop and nurses continue to take on more of the roles previously considered to belong to doctors. There needs to be ongoing encouragement towards an environment of power sharing across the whole of the PHCT and the continued devolvement of clinical responsibility to the team members with the most appropriate skills and knowledge. Any process of change, however, is slow and must start with the gradual changing of attitudes between professions. Multiprofessional learning from initial training could help to change attitudes and beliefs over time, and some educational institutions are currently examining ways of taking this forward.
There are many within primary care who currently feel overwhelmed by information overload and the excessive pace of change in their clinical practice, and the move towards integration is often seen as threatening. Practice-based learning may be a way of enabling practitioners to focus on problems within their practice and start to develop solutions that would potentially enable them to cope with the ever-changing face of primary care.
 
The way forward
Health improvements, evidence-based practice and quality of service are an integral part of the way forward for the NHS,(6,9) and within primary care the development of effective multiprofessional patterns of working through multiprofessional learning has to be recognised. Primary care resources need to be used efficiently to provide high-quality, comprehensive care and patients should be able to access professionals with the most appropriate skills where roles are based on partnership and teamwork.(10)
However, more work needs to be carried out to highlight the benefits of multiprofessional learning within both primary and secondary care. PCGs and PCTs also need to recognise the important role that multiprofessional learning could play in their plans to improve collaboration and cooperation between all healthcare professionals to improve patient care and available services. Work also needs to be undertaken to move this development through successfully to the next stage within the continuing education framework by the educational institutions.
The overall message to take away is that multiprofessional education could be a highly effective way for all community healthcare professionals working within primary care to move the agenda forward and develop primary care services.

References

  1. Department of Health. Primary care: delivering the future. London: HMSO; 1996.
  2. Atkins JM, Walsh RS. Developing shared learning in multiprofessional health care: for whose benefit? Nurse Educ Today 1997;17:319-24.
  3. Smail J. Shifting the boundaries in practice nursing. In: Gastrell P, Edwards J, editors. Community health nursing. London: Ballière Tindall Publishers; 1996. p. 259-72.
  4. Elwyn G, Övretveit J. Integrated nursing teams and the PHCT: integral or alternative? In: Elwyn G, Smail J, editors. Integrated teams in primary care. Abingdon: Radcliffe Publishers; 1999. p. 37-55.
  5. Carey L. The future of practice ­nursing. In: Carey L, editor. Practice nursing. London: Ballière Tindall Publishers; 2000. p. 308-30.
  6. Department of Health. The new NHS: modern, dependable. London: HMSO; 1997.
  7. Kernick DP. Nurses and doctors in primary care: decisions should be based on maximizing the cost ­effectiveness of a system of primary care and not the dictates of historical precedent. Br J Gen Pract 1999;49:647-9.
  8. Herzberg J. Tribes or teams? The challenge of multiprofessional education. Hosp Med 1999;6(7):516-8.
  9. Department of Health. A first class service: quality in the new NHS. London: HMSO; 1998.
  10. Yerrell P, Reed A. The anachronism of policy for nursing in general practice: conceptualising a way forward.Nurs Times Res 1997;2(4):245-57.