MDT

MDT in the Community: Who does What?

GPs work with a wide range of professionals from other disciplines and often directly refer to colleagues in the multidisciplinary team (MDT) both within their practice and localities. It is also helpful here to understand the range of professionals in Primary Care and their roles. If you have a chance to attend your practice meeting, then try to get an understanding of which professionals are in attendance and their roles – this may help you to enhance your understanding of how a community team works together to benefit patients.

Care Navigator

Their aim is to ensure that patients are able to participate fully in their daily life and their community. They help patients to identify and access systems and support available within their local health and social care sector. Roles may include: assistance with filling out forms, referral to social groups, help arranging transport to attend social groups/appointments, helping to identify available support from housing, benefits or debt management services. They are generally funded through third party organisations, e.g. charities, and therefore their availability is more vulnerable to being cut.

Dietician

Dieticians aim to promote good health and prevent disease through food. They advise people to help them make informed and practical choices about their food and nutrition. They also assess, diagnose and treat dietary and nutritional problems. Some have a role in teaching and informing the public and health professionals about diet and nutrition. They work in both community and inpatient settings, but their roles differ somewhat. Hospital dieticians tend to focus primarily on short-term malnutrition and sudden changes in dietary intake, e.g. post-surgery. Community dieticians also assess and treat malnutrition but may also help patients with longer-term nutritional problems, e.g. obesity-related diabetes, or anorexia, to address their diet over time.

Health Care Assistant (HCA)

HCAs work under the guidance of a qualified health care professional (usually a nurse). They deliver more routine health care such as health checks, phlebotomy and health promotion work.

Health visitor

They work with children under 5 and their families to ensure that all children receive the best possible start in life. They provide postnatal (and occasionally antenatal) support to families by offering advice on feeding and parenting skills such as behaviour management, preventing accidents etc. They assess children’s growth and development at regular stages (usually first few weeks, 1 year, 2.5 years, and preschool as a minimum)

Midwife

Community midwives look after women both antenatally and immediately postnatally (first 14 days after birth). Teams commonly come to practices to see women and specialist midwife teams exist for complex pregnancies, e.g. teenage mothers, mothers with addiction and/or mental health problems

Occupational therapist (OT)

The primary goal of the OT is to enable the patient to participate in activities of daily living. They often carry out home visits to gain a more accurate understanding of the patient’s life. This may involve: advising on how to approach a task differently, using specialist equipment to facilitate daily tasks, adapting the living/working environment.

Palliative care nurses

These specialist nurses work with patients at the end of their lives. They help with medications, physical and emotional support of patients and their families to ensure that the end of their life is peaceful. Macmillan nurses are a particular type of nurse who work with oncology patients and also have a lot of experience in end of life care.

Pharmacist

Pharmacists have a strong scientific background in pharmacology and the use of medications. They are able to rationalise medications with a patient, monitor their concordance, discuss side effects and suggest safe ways to take medications, e.g. particular time of day, dosset box, observed dosing for controlled drugs.

Physician Associates (PAs)

Physician associates are clinical graduates trained in the medical model. They must pass an intensive 2 year university course at diploma or masters level to learn clinical knowledge and skills after completing a 3 year biomedical or healthcare related degree. They train in both the acute sector and primary care to gain a rounded patient centred clinical experience.

Physiotherapist

Physiotherapists focus on building strength and health through physical activity. They are experts in musculoskeletal health and a subset of physiotherapists have undergone further training to become extended scope practitioners. Extended scope practitioners have more experience and expertise and are able to work with more complex musculoskeletal problems, diagnose patients and sometimes request appropriate scans.

Podiatrist

They work with people’s feet and legs. They diagnose and treat abnormalities and offer professional advice on care of feet and legs to prevent foot problems. In the NHS, they see many patients at high risk of amputations, such as those suffering from arthritis or diabetes, and can give advice on both toenail and foot conditions.

Practice nurse

Nurses see patients in the practice to promote health and prevent disease. They may have a number of roles including wound management, travel health advice and vaccinations, family planning and women’s health including cervical smears, smoking cessation.

Psychologist

Psychologists work with patients in the community who are suffering with depression, anxiety or other mental health difficulties. They offer psychological therapy but are not responsible for the diagnosis or medical management of mental health conditions.

Social Prescribers

Many people in the UK are in situations that have a detrimental effect on their health. Factors contributing to health inequalities can include financial, educational, poor housing, low self-esteem, isolation, relationship difficulties, and physical and mental health problems. A GP can quickly work out that the traditional options might have only a limited impact if, for example, poor housing is a factor in a person’s emotions; finance and employment concerns also have an adverse impact. It has been estimated that around 20% of patients consult their GP for what is primarily a social problem.

Social prescribing supports the individual, families, local and national government, and the private, voluntary and community sectors to work in collaboration. Social prescribing can offer many people a personalised and flexible offer of support back to health at a pace that is appropriate to the person. Social Prescribers can signpost patients to non-medical activities with the aim of improving their wellbeing. These could include joining an exercise, healthy cooking or art class; joining a walking group, a cycling group; volunteering at a community garden or community café; visiting an isolated person or walking a dog for a neighbour.

Social worker

Social workers work with individuals and families to help them live more successfully. Meet with individuals and/or their families to discuss their specific needs and try to implement support to help with this. This may involve putting in a care package, advising the patient of available support groups or financial support, meeting regularly with the patient/their family to monitor and review progress. Social Workers also perform capacity assessments and take lead in safeguarding of adults and children.

Speech and Language Therapist (SLT)

They provide treatment, support and care for patients with communication and/or swallowing difficulties.

Do not forget the range of administrative staff that are based at the practice and in the community also! On your GP3 attachment, aim to spend some of your time with the administrative support to more deeply understand the complexity of how Primary Care is organised.