Primary health care teams re-engineered

The existence of a multidisciplinary 'team' in general practice-based primary care is now widely questioned. The requirements for effective teamworking (appropriate tasks, leadership, functional maintenance and peformance feedback) are seldom met. As more care devolves to primary care and as the practice-based organisation becomes more complex, the tension between expressed patient preferences (personal continuity of care) and the push for 'teamwork' is clearly observable in general practice. Does the concept of re-engineering (where services are organised on the basis of a streamlined process) offer a way forward? These issues are explored in this article and possible practical developments outlined.