The Latin word ‘multi’ means ‘many’; therefore multidisciplinary/agency working refers to two or more disciplines or agencies working with a patient, client or family. Crucially, however, these terms do not imply formal partnership or collaborative working between disciplines or agencies, as traditional divisions of professional knowledge and authority are retained in this way of working (Leathard 2003, Masterson 2002, Sheehan et al 2007). Multidisciplinary team members undertake independent assessments, and set goals and plan care in isolation (Batorowicz and Shepherd 2008). The multidisciplinary/agency team is composed of different professionals who work according to their particular scope of practice (Sheehan et al 2007). For example, primary care teams may be considered multidisciplinary, being composed of a range of practitioners such as GPs, practice nurses, district nurses, health visitors, etc. This form of working may be thought of as teams of practitioners from different backgrounds making ‘different but complementary’ contributions to healthcare (Leathard 2003: 5). Any collaboration between disciplines or agencies is invariably conducted on an informal basis.

Where working practices become more integrated, the term ‘joint-working’ is commonly used (Sloper 2004); for example, health visitors and learning disability nurses working together to deliver parenting programmes for parents with learning disabilities, occupational health and school nurses working collaboratively to prepare children for the transition to the workplace or district nurses and community psychiatric nurses planning joint initiatives to promote the mental health of the elderly.

Warmington et al (2004) discuss how multidisciplinary working results in practitioners working in isolation in the planning and delivery of services, leading to duplication of care. Yet Borrill et al (2002) state how this way of working is a prescription to put right the perceived short fallings of the NHS. It is unlikely, however, that Borrill et al’s interpretation of multidisciplinary/agency working is similar to that proposed in this work, illustrating inherent difficulties evident when attempting to distinguish between concepts and approaches where different understandings exist.

Borrill et al’s (2002) understanding appears more akin to this work’s interpretation of interprofessional/agency working. The prefix ‘inter’ means ‘between’ and implies interaction between two or more different groups (Leathard 2003). Therefore, interprofessional/agency working is taken to mean two or more agencies working together in planned and formal ways and not simply through informal networking (Warmington et al 2004). Goals and care plans are formulated following consultation from all team members and practitioners share and even relinquish their professional claims to specialized knowledge in circumstances where other professional disciplines can deliver service user requirements more efficiently (Batorowicz and Shepherd 2008, Masterson 2002). Interprofessional working is characterized by blurring of professional roles where shared problem solving is performed in planning care and interventions (Sheehan et al 2007). Interestingly, ‘trans’ interprets as ‘across’ and also implies professionals working across traditional role boundaries – but to an extent where professional boundaries begin to actually dissipate, resulting in professionals developing expertise in other practice areas (Batorowicz and Shepherd 2008). Sloper (2004) cautions against confusing ‘interprofessional’ with ‘intraprofessional’ – a term used to denote differing specialist disciplines arising from one professional group, such as in the case of community nursing involving health visitors, district nurses, community psychiatric nurses, practice nurses, school nurses, etc.

Accepting that confusion surrounds definitions of multidisciplinary, joint and interprofessional working, Jones and Thomas (2007) still believe that all relate to practitioners working closely with colleagues from other professions in ways that promote the blurring of boundaries. One of the major benefits perceived from partnership or collaborative working is the facility to reduce duplication of practice through the reorganization of services, where one discipline or profession takes responsibility for an aspect of care hitherto performed by all – so that role blurring occurs as the team becomes more integrated. ‘Boundary blurring’ is one of the more recent terms to emerge from healthcare policy and it is interesting how effective interprofessional working is often defined in terms of practitioners recognizing commonalities of practice and reorganizing service delivery to avoid duplication of practice. Indeed, Masterson (2002) notes the move towards the blurring of boundaries between professions as the tendency and drive for certain professional activities to merge occurs. However, while boundary blurring is a term receiving significant attention, it too appears to be an ill-defined concept that requires clarification.

Rushmer and Pallis (2003) explain how boundary blurring does not mean that one agency is able to deliver the entire expertise of another – if it did then there would be no need for the agency in the first place. What it means is that while professions each possess unique qualities specific to them, they also share commonalities of practice that one professional could perform for all. Examples such as nurses undertaking prescribing, previously considered the sole domain of the medical profession, is one way that professional boundaries have already blurred. Not that boundary blurring only applies to professionals; it also occurs following abdication of professional roles to unqualified staff (Goble 2003).

Dowling et al (2004) believe that existing divisions and demarcations between professions and professionals will need to be set aside in order to rise to the challenge to work differently and collaboratively in the interests of patient or clients. However, expecting practitioners to identify commonalities in working practices and relinquish aspects of their role is not as easy as it may seem. Boundary blurring may be threatening for professionals, nervous about losing their professional identity and status, and this factor may seriously hinder integrated partnership working. Support and guidance are key ingredients in the development of new roles and, crucially, professionals need to be explicitly clear regarding their understanding of shared commonalities of practice, to ensure they work according to their level of competence. In fact, it is clarity of roles and explicitness that Rushmer and Pallis (2003) believe will facilitate greater integrated working partnerships rather than role blurring, which after all implies vagueness and lack of clarity.

Ultimately, the many definitions that exist to describe the different ways professionals work together overlap, coincide, and lack clarity. However, Hudson (2000) notes that while the what remains vague, the why of partnership working is crystal clear. Partnership working is reported to improve communication, prevent duplication of service delivery, improve understanding of different professional roles, enhance role development and, most important of all, improve service delivery to users. As such, partnership working will undoubtedly remain centre stage in government plans to deliver quality health and social care services. However, research evidence to support these claims is scarce, and far from partnership working being considered a harmonious process, different organizational cultures and numerous professional tensions can contribute to this being viewed as a threat to professional autonomy (Warmington et al 2004).

A growing body of evidence informs on specific benefits experienced by practitioners from working collaboratively as well as factors that contribute to interprofessional working. For instance, Freeman and Peck’s (2006) research explored the impact of partnership working in integrated specialist mental healthcare provision from the perspectives of front-line practitioners, service users, carers and service managers. Their findings revealed how staff involved in joint-working teams found opportunities to discuss clients’ needs a valuable exercise, providing access to a range of perspectives hitherto not available. Co-location of teams reduced feelings of isolation and enhanced working relationships, and staff reported greater satisfaction and found their work to be more rewarding from having time and opportunities to work with previously difficult-to-engage clients in therapeutic ways.

Similarly, Hudson’s (2007) findings revealed how interprofessional working between social workers, district nurses and housing officers facilitated the development of trust and respect between professionals as well as promoting clearer understandings of each other’s roles and responsibilities, promoting the sharing of a common vision. The benefits of shared databases, access to IT resources and joint training also contributed to positive relationships. In addition, Larkin and Callaghan (2005) found statistically significant relationships between joint supervision, joint documentation and shared risk policies and increased awareness among professionals of interprofessional roles and responsibilities. Similar findings to the above have been reported by Molyneux (2001) and Shaw et al (2005) and together findings from these studies inform on a range of factors which promote interprofessional working (Box 21.2) and benefits experienced by practitioners as a result (Box 21.3).