Professional tribalism may be seen as a problem within a complex organisation such as general practice. What may be the problems managers face in developing integrated professional team working?

The Primary Care Health Team (PCHT) is generally considered to be the central form of organisation within primary care and is believed to be the most efficient style of inter-professional working (Peckham et al 2003). Definitions of a ‘team’ are often problematic; however, Wiles and Robinson (1994) offer a definition that sums up the key characteristics,

“a group of people working at or from a primary care practice with common goals and objectives relating to patient care.” (pp.324)

The PCHT developed from the Doctors Charter (1966) which incorporated changes to GPs terms of service that encouraged GPs to designate work to suitable staff, and introduced a 70% return for employing a nurse within the practice (Royal College of General Practitioners 1998). However, the rise of the GP Contract, rising workloads and larger practices cemented the theory and practice of teamwork within primary care (Ibid 2003). This text will……..

An improvement in patient centred care has long been a nursing tradition. However, individual enthusiasm and commitment as oppose to top level strategic development (Leveson et al 2000). Professional tribalism and organisational constraints have at times, suggests Mullaly (2001) prevented such innovation. The challenge health professionals working within the National Health Service (NHS) have is to make these ways of working mainstream throughout the NHS. Good teamwork within all areas of the NHS is key to the success of the NHS Plan (DoH 2000).

Inter-professional working implies a division of labour. This division exists in the sense of the numbers and range of professionals working together within Primary Care. For example, doctors, nurses, paramedical and ancillary staff. Additionally, it is also relevant as this mixture of professional skills delivers healthcare to patients. These divisions are not binding however, as they change overtime in response to technological changes, know ledged advances, and political changes (Flynn 1999) It is the consequence of such divisions and changes, suggests Peckham et al (2003) that issues concerning power and conflict occur within inter-professional working. This has direct implications in the way roles, functions, decision making and leadership are all designated or substituted.

The division of labour is becoming increasingly complicated as the range and combination of professionals work within Primary Care. General Practitioners (GPs), states Peckham et al (2003) are possibly the central players within the current division of labour. Sibbald (2000) claims, within Primary Care GPs are the dominant medical speciality, whereas within nursing there are several different specialities. This division affects relationships between both GPs and nurses and GPs and other specialities. Furthermore, in recent years, both nursing and medicine have been affected by the introduction of new public management. For example, professionals as managers and the management of clinical performance. Conversely, Williams (2000) suggests, the impact of public management contributes to growing insecurity within the healthcare professions.

The theory of change is in itself a subject that lies outside the boundaries of this text. However, Pringle (1993) believes appropriate management of change raises the chance of a good outcome, and that the need for change can be turned into an opportunity. Moreover, empirical evidence from many organisational settings shows if people are involved within the process of change they are more likely not to resist (Field & West 1995). It is therefore in the interests of primary care trust managers to keep staff on all levels informed, and actively involve them in the process of change. Nonetheless, Atkinson & Hayden (1993) advise that whilst support and facilitation perform well with problems relating to adjustment, change can be expensive, time consuming, and still fail.