Dr Burnt-out writes to Pulse about the rise of shared decision-making in primary care following the Fuller stocktake report
It has come to my attention that many recent articles and opinion pieces in the GP press have reported that GPs should now work as part of multidisciplinary teams (MDTs) and neighbourhood teams following the publication of the Fuller stocktake report, which outlined the future direction of general practice.
The opinion seems to have taken hold in primary care that decision-making within an MDT and neighbourhood team is inherently somehow much better and more appropriate than individual and ‘not-shared’ decision-making in terms of patient management and clinical decisions.
So, are decisions made by teams and multidisciplinary groups always better and more superior than those made by GPs and other clinicians working alone? Is working together in large teams the most valid, efficient and effective way of making these decisions? Are the decisions that are made proven to be superior? Is there not huge scope for inefficiency, poor time-management, duplication and confusion when multiple parties are involved in decision-making? And what types of decisions are being made?
A lot of decisions we make as GPs are binary; ‘either/or’ decisions. For example, after you see a patient:
- Either you prescribe medication, such as antibiotics, or you don’t
- Either you make a specialist referral, or you don’t
- Either you refer someone into hospital, or you don’t
- Either you agree to do what the patient wants you to do, or you don’t
- Either you do something, or you do nothing
- Either you request investigations, or you don’t
Many decisions we make as GPs are of this nature. Can someone please tell me how decision-making as part of a large MDT or neighbourhood team can help with these decisions, rather than an individual experienced clinician using all their experience and clinical acumen?
Surely, an experienced GP making these decisions is likely to be more time-efficient, accurate and appropriate than any decision made by a group or committee of various people.
The way the PCN myth has developed has included the notion that working in an MDT is somehow better, more inclusive, more accurate, more moral and more efficient than decisions, diagnoses and management plans made by an experienced individual GP.
Dr Burnt-out is a GP in London