Abstract
The increasing pressures in Primary Care are well documented, exacerbated by the pandemic, an aging population, workforce deficits and increased waits for secondary care.
The pressure resulted in 16 GP practices in Northern Ireland returning their contracts to the Commissioner .Health and Wellbeing 2026 [1] set out a vision for an enhanced primary care service. The MDT Programme builds on this vision to invest in primary care to ensure there is a multidisciplinary team focused on the patient.
In 2019, South Eastern Health and Social Care Trust (SEHSCT) was commissioned to deliver a pilot of multidisciplinary teams in general practices. Subsequently, 28 GP practices have been enhanced through MDT funding. The MDT model provides a renewed focus on prevention /early intervention by embedding First Contact Physiotherapists (FCP), Mental Health and Social Work(SW) roles within primary care along with investment in District Nursing and Health Visitors.
MDTs works collaboratively with community and voluntary partners. MDTs address health inequalities and improve access to care by:
- Better meeting existing demand for primary care
- Supporting service reform-the shift of care into community
- Boost capability/capacity for early intervention and prevention
- Stabilise GP practices
Multidisciplinary teams consist of:
Mental Health Practitioners
First Contact Physiotherapists
Social Workers
Health Visitors
District Nurses
The MDTs work alongside GP practice staff .Patients are signposted directly to SW, FCPs or mental health staff. MDT staff can identify and respond earlier to patients’ issues providing support, treatment and care. 182,000 people have direct access to MDTs. In 2022, SW managed 7472 referrals and 23706 service user contacts and FCPs undertook 32074 patient treatments.
FCPs prescribe medication, refer for diagnostic tests and undertake joint injections .Patients have access to local, expert musculoskeletal assessments /early interventions .Last year 88% of patients referred to FCP had their care managed in primary care only 4.7% required onward referral to hospital services.
The MH staff provide comprehensive mental health assessments / psychological interventions, CBT, medication advice and anxiety management. Through interventions only 4.2% patients required onward referral to secondary care mental health services.
Social work staff work closely with the community and voluntary sector .Innovative use of the MDT social work seed funding in 2022 has resulted in the support of 161 projects with 22,362 patient contacts. Evaluation of these groups demonstrated improvements in physical and mental wellbeing and addressing social isolation. The benefits of connecting across these sectors have been the collaborative gain to bringing resources together and identifying local population health and social needs.
One of the aims of the MDT programme was to support GP practice stability. Initial results show the positive effects that the MDT team have in both stabilising practices and attracting GPs to work in MDT practices.
Next Steps: The MDTs remain a key priority within the health and social care transformation. Evidence suggests this approach results in patient issues being resolved more quickly, reducing the need for referrals elsewhere, easing demand on hospitals and supporting GPs in practices
[1] health-and-wellbeing-2026 (health-ni.gov.uk)