Multidisciplinary Team Working in NHS Community Services: From Governance to Daily Practice
Multidisciplinary teams (MDTs) are central to NHS clinical pathways and multidisciplinary working and wider NHS community service models and pathways. However, MDT effectiveness depends less on structure charts and more on operational clarity. This article explores how MDTs function in daily practice, how accountability is allocated, and how services evidence safe, risk-aware decision-making within integrated community settings.
Defining Accountability Within MDTs
Ambiguity around “shared responsibility” is a common safety risk. Effective MDTs explicitly document:
- Accountable clinical lead per pathway
- Decision-making thresholds
- Escalation triggers
- Recording standards
Accountability does not negate collaboration; it clarifies it.
Operational Example 1: Community Falls MDT
Context: A community falls prevention service integrating physiotherapy, occupational therapy and nursing.
Support approach: Weekly MDT review of high-risk cases, named clinical lead for each patient.
Day-to-day delivery: Referrals are triaged using agreed frailty and falls risk criteria. In MDT meetings, therapy progress, safeguarding concerns and medication issues are reviewed. Decisions are recorded with responsible professional and review date.
Evidence of effectiveness: Audit sampling shows reduced repeat falls and documented safeguarding checks in 100% of high-risk cases. Commissioners receive quarterly outcome reports.
Operational Example 2: Complex Discharge MDT
Context: Integrated discharge team supporting medically optimised patients with complex needs.
Support approach: Daily board round with hospital liaison, community nursing and social care representation.
Day-to-day delivery: Each case review confirms discharge criteria, community capacity and risk mitigation. Where disagreements arise, escalation routes to senior clinical leads are triggered the same day.
Evidence of effectiveness: Reduced delayed discharges and improved documentation of escalation decisions. Governance minutes evidence oversight of high-risk cases.
Operational Example 3: Mental Health and Physical Health Interface MDT
Context: Community pathway for individuals with severe mental illness and long-term physical conditions.
Support approach: Joint reviews between mental health practitioners and community nurses.
Day-to-day delivery: Risk registers include safeguarding vulnerability, medication adherence and physical deterioration indicators. Escalations to crisis services are documented with clinical rationale.
Evidence of effectiveness: Audit demonstrates improved physical health monitoring and reduced unplanned admissions.
Commissioner Expectation
Commissioners expect MDT models to reduce duplication and prevent avoidable admissions while maintaining clear lines of accountability. Evidence should demonstrate that MDT decisions are recorded, reviewed and aligned with contract KPIs.
Regulator / Inspector Expectation
CQC inspectors assess whether MDT working supports safe, effective and responsive care. They look for clarity of responsibility, safeguarding integration and evidence that learning from incidents informs MDT practice.
Risk Escalation and Safeguarding
Effective MDTs embed safeguarding awareness into routine reviews. Escalation triggers must be documented, and professionals must understand when to override pathway norms in favour of immediate safety.
Positive risk-taking requires recorded rationale, capacity assessment and agreed review intervals.
Review and Continuous Improvement
MDT effectiveness should be audited through:
- Decision sampling
- Outcome benchmarking
- Incident trend analysis
- Feedback from service users
Where themes emerge—such as delayed escalation or unclear documentation—corrective action plans must be tracked and reviewed at governance meetings.
When MDT working moves from informal discussion to structured, accountable practice, community services can demonstrate real integration, defensible decision-making and measurable impact.