4: Team Based Care
High-performing practices view teams as a necessity for the survival of adult primary care. Clinicians without teams caring for a panel of 2,500 patients would spend 17.4 hours per day providing recommended acute, chronic and preventive care.
Yet panel size will inevitably grow as the shortage of adult primary care clinicians worsen. Many exemplar practices have created teams with well-trained nonclinicians who add primary care capacity. Building teams that add capacity is called “sharing the care”.
A problem with large teams is that patients may not identify 1 or 2 team members who know them well. To address this issue, high-performing practices generally organise their teams around teamlets – a stable pairing of a clinician and clinical assistant(s) who work together every day and share responsibility for the health of their panel. Some practices have increased productivity or panel size by having 2 or 3 clinical assistants for each clinician. Often a larger team – perhaps a registered nurse, social worker, pharmacist, and behaviourist – supports several teamlets.
Some high-performing practices introduce side-by-side colocation of clinicians and nonclinician staff in common work areas (called pods), agree on ground rules that establish a respectful culture, perform daily huddles, and write standing orders empowering nonclinician staff to share the care. Practice may increase their panel size by assigning a subpanel of patients with uncomplicated chronic conditions to nurses or pharmacists who manage the chronic condition using standing orders.