Table 1 Core Issues of Teamwork in General Practices

Engaging a multidisciplinary team with diverse expertise and approaches

Tallia and colleagues identified the importance of respecting each other's roles and acknowledging the diversity (of expertise) each member could bring to the team. Be mindful of new ways of working [14].

The GPs training workshop provided the initial information exchange between the multidisciplinary team. The facilitator's subsequent visits served as a bridge to link GPs to the AHPs with the appropriate skills and resources.

Trust (delegation)

Stewart's Patient-centred Care Model - GPs need to understand the roles played by AHPs and develop trusting relationships with them [15].

GPs Training workshops provide face-to-face interactions with AHPs where GPs and PNS were informed what kind of services AHPs offered and gauge the quality of such services during the case study discussions presented by the AHPs

Effective communication

Tallia and colleagues emphasised the importance of using rich means of communication (e.g. face-to face Vs faxed documents) [14]

A 3-way communication between GP-Patient-AHP via phone was modelled during the workshop and encouraged during follow up visits

Organizational support and team composition and location

Xyrichis pointed out the impact of team structure and processes on inter-professional team-working. E.g., team premises, size and composition, and availability of organizational support [11].

The facilitators provided the necessary resources and support for non-clinical staff (e.g. Practice Mangers or receptionists) of the practices, e.g. the appropriate software to update the computerised patient records and to run regular patient recalls, secure electronic transfer of patient data between the practice and AHPs, access to on-line resources available via the DGP's websites. The facilitators also helped staff members clarify their roles and responsibilities to avoid work duplications and promote efficiency.

Balance between focusing on tasks Vs social interactions

The College of Family Physicians of Canada identified 'investing time in intra-group' and 'inter-disciplinary communication' as key success factors for inter-disciplinary collaboration [12].

The facilitators encouraged the practice staff to have regular staff meetings to reflect on current issues related to chronic care management and exchange ideas, setting common goals and Plan-Do-Study-Act (PDSA) cycles. Regarding inter-disciplinary communication, the facilitators also organised 'Small Group Learning' Seminars at the local Division of General Practice for GPs and AHPs to exchange ideas on a particular topic of interest (e.g. Co-morbidities in patients with Chronic Disease)

Resources and Tools

Sicotte stated the need for resources and tools to support teamwork and enable teams to achieve their objectives [10].

The facilitators provided the necessary resources and tools to suit each practice's unique circumstances (IT support) as well as general tool-kits (e.g. TCA templates)