Multidisciplinary Team Working in NHS Community Services: From Theory to Daily Practice
Multidisciplinary team working is frequently cited as a strength of NHS community services, yet in practice it is often under-defined and inconsistently delivered. Many MDTs exist in name but lack clear purpose, decision-making authority or accountability. Effective MDT working depends on how teams function day to day, how decisions are made, and how this links into wider clinical pathways and multidisciplinary working and established community service models and care pathways.
For commissioners and regulators, MDT effectiveness is increasingly assessed not by attendance lists but by evidence of coordinated, outcome-focused decision-making.
What MDT Working Means in Community Services
In NHS community settings, MDTs typically include professionals from nursing, therapy, medicine, mental health, social care and voluntary sector partners. However, simply bringing professionals together does not guarantee integrated practice.
Effective MDT working requires:
- Clear purpose and scope of the MDT
- Defined decision-making authority
- Agreed information-sharing processes
- Documented outcomes and actions
Operational Example 1: MDT Function in a Community Rehabilitation Service
Context: A community rehabilitation service holds weekly MDT meetings but struggles to evidence impact.
Support approach: The MDT remit is clarified to focus on goal setting, risk review and escalation planning.
Day-to-day delivery: Each case discussion results in documented decisions, assigned actions and review dates.
Evidence of effectiveness: Improved consistency in care plans and reduced unplanned escalations.
Decision-Making and Authority Within MDTs
One of the most common weaknesses in MDT working is unclear decision-making authority. Without clarity, discussions become advisory rather than actionable.
Good practice includes:
- A named MDT chair with authority
- Clear escalation routes for unresolved disagreement
- Documented clinical rationale for decisions
Operational Example 2: Managing Professional Disagreement in an MDT
Context: Conflicting views arise within a complex care MDT regarding risk tolerance.
Support approach: A structured decision-making framework is introduced.
Day-to-day delivery: Disagreement is recorded alongside agreed mitigation and review points.
Evidence of effectiveness: Reduced conflict and clearer accountability.
Governance and Assurance of MDT Practice
MDT working must be subject to governance in the same way as any clinical process. This includes audit, supervision and learning from incidents.
Commissioner expectation
Commissioners expect MDTs to demonstrate how decisions contribute to pathway outcomes and system efficiency.
Regulator expectation (CQC)
CQC looks for evidence that MDT working supports safe, coordinated care and that decisions are recorded, reviewed and learned from.
Operational Example 3: MDT Review Following a Safeguarding Incident
Context: A safeguarding incident highlights gaps in MDT communication.
Support approach: MDT processes are reviewed and strengthened.
Day-to-day delivery: Safeguarding considerations become a standing MDT agenda item.
Evidence of effectiveness: Improved risk identification and escalation.
Why MDT Working Is a Critical Capability
Well-functioning MDTs enable integrated care, shared accountability and defensible decision-making. When poorly governed, they create risk and fragmentation.
Strong MDT working is therefore a core indicator of system maturity in NHS community services.