Not just an MDT

Transcript

Introduction

Welcome to Neighbourhood Health Conversations, the podcast exploring how we can make health and care more human, connected, and effective. Today we’re diving into a question that’s been coming up again and again from our members. Are neighbourhood health teams just MDTs on steroids? Or is there something fundamentally different going on? It’s a great question and an important one because the way we answer it shapes the future of integrated primary care and the future of the NHS. So why does this question matter?

Why This Question Matters

For decades, multidisciplinary teams have been a bedrock of community care. They bring different professions together, wrap support around people with complex needs, and improve coordination. But as we look to the future and as integrated neighbourhood health teams become central to the 10-year plan and the neighbourhood health ambition, we need to understand something clearly. Neighbourhood health teams aren’t just bigger MDTs. They are different in purpose, mindset and method. MDTs have proved essential. They saved lives, prevented admissions and supported countless people through illness and deterioration. But they were designed for a particular moment in the system’s history, a time when we built services around referrals, caseloads, and reactive responses. Neighbourhood health teams are designed for something else, a population-based, proactive, holistic, comprehensive and co-produced way of supporting health and well-being. And crucially, the people who will make great neighbourhood health teams possible are the very people working in MDTs today.

What MDTs Already Do Brilliantly

So what do MDTs already do brilliantly? Well, let’s start by recognising the great contribution that they make. They are multi-professional, skilled, relational, and they often operate in extremely challenging contexts, time poor, demand heavy, and dealing with people in moments of acute need and crisis.

MDTs do a particular type of work exceptionally well, responding quickly when someone deteriorates, supporting defined clinical conditions, operating within clear referral criteria, holding a finite caseload, they deliver focused, often time-bound interventions. So in many ways, MDTs have been the best version of a reactive care model. They join up professionals in a system that’s not really being designed to join itself up. And the people working in MDTs know better than anyone the limitations of that model. The moments when the people they’re providing care and support for need more, earlier or different care and support. But the system around them hasn’t been built to provide it. That insight is precisely what makes MDT staff natural leaders of neighbourhood health teams.

Why Neighbourhood Health Teams Must Be Different

So why must neighbourhood teams be different? Well, neighbourhood health teams step into a different space, a space of health creation, prevention, around what really matters to people over time. So let me draw the contrast clearly. So under population responsibility, MDTs support a caseload. Neighbourhood teams support a population, including those who haven’t yet appeared on any caseload. The hidden health and well-being need beneath the surface. Neighbourhood teams need to be more proactive rather than reactive. MDTs tend to mobilise after something has happened, a fall, a crisis, a decompensation. Neighbourhood health teams need to ask who is likely to fall next month? Who is one crisis away from hospital? Who is lonely, struggling or declining but hasn’t yet asked for help who we don’t know about. They need to operate upstream alongside community health and well-being workers, health coaches and voluntary sector partners to reach people earlier and differently.

From Condition-Based Care to Holistic Support

Neighbourhood health teams need to be holistic rather than condition-based. An MDT might focus on frailty, heart failure, COPD or falls. Neighbourhood health teams look at the person around, their physical, mental, emotional, social and environmental needs, the wider determinants of their health and well-being. And international evidence from Gusundi’s Kinsektal to Chenmed, from Dartmouth Health Connect to Bromley Baibo shows the same truth. From Professional Collaboration to Community PartnershipPeople don’t live in condition-specific silos. Their needs interact. So must we.

From Professional Collaboration to Community Partnership

Neighbourhood health teams need to ensure that care and support models are co-produced, not just clinically convened. MDTs are excellent professional collaborations. Neighbourhood health teams are professional community partnerships involving voluntary groups, social care, housing, community connectors, and the community, the people within the community themselves.

They’re anchored in community, not anchored in a meeting room. Neighbourhood health teams create ongoing relationships, not simply episodic contacts. MDTs tend to engage when need is acute and it tends to be time limited. Neighbourhood health teams need to engage continuously, offering belonging, continuity, trust and agency over time.

Why MDT Staff Are Essential to Making This Work

Now here’s the delicate but essential part. Neighbourhood teams only work when the people from MDTs help design them. And here’s why MDT colleagues should feel empowered, not diminished. They already see the gaps. MDT staff know the downstream costs of upstream neglect better than anyone. They see the revolving door of emissions, the avoidable deterioration, the social factors that medical care alone can’t touch. They understand complexity. MDTs already work with people whose needs don’t fit neatly into one diagnosis or one service. That experience is foundational to holistic neighbourhood-based care. They are frustrated by system fragmentation.

MDT staff often feel powerless when they can spot what’s needed but the system doesn’t flex. Neighbourhood health teams should be able to offer precisely the autonomy, flexibility and subsidiarity they’ve been waiting for. They’re also skilled team players. MDTs understand shared goals, mutual respect and relational coordination, the very ingredients that neighbourhood working relies on. So the message is clear.

Evolution, Not Replacement

Neighbourhood health teams aren’t replacing MDTs. They are what MDTs should become when you give them the mandate, the ability to work with partners and the flexibility to do what they always knew was possible. The shift to neighbourhood health teams isn’t an indictment of MDTs. It’s the evolution of their strengths into something broader, deeper, more sustainable. It’s the moment when reactive expertise becomes proactive influence, where disease management becomes health creation, where professionals become partners with each other and with their communities.

Conclusion

And that evolution will only succeed if MDT colleagues are part of leading the necessary change in partnership with their communities. They are the ones who hold the relationship with people, understand the patterns, feel the gaps, and have the compassion and insight to shape something new. Thanks for listening to Neighbourhood Health Conversations. If today’s episode has sparked ideas, especially if you’re working in an MDT right now, please share it with your colleagues, your teams and your communities. And join us next time as we continue to explore how we can build neighbourhood health that is human, connected and effective for everyone we serve.