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In Sedgefield, County Durham, single assessment and multi-agency working ideas are more than just rhetoric. Adult social care, health, and housing departments are being reorganised into five neighbourhood level multidisciplinary teams, with district nurses, social workers and housing support officers all working together.

Ann Workman, community partnership manager, has been leading the pathfinder team since May last year and enthuses about the benefits the reorganisation is bringing to both service users and staff. "It's a tremendous way to work," she says. "The system is so much more immediate and flexible. Staff feel they are more effective. Before, district nurses would spend an inordinate amount of time trying to deal with social care and housing issues. Now, staff don't have to chase each other."


Consultation with users and carers has been an important part of the new service. "They made clear that they didn't care whether we were health or social care but they wanted local services and a single point of access. They were fed up with people asking them the same questions."

A single assessment process backed by sound IT and administration support saves time for both staff and users. "Staff don't have to go back and ask all the same questions over again. A social worker or nurse might go out on an emergency case and find the problem has a housing angle, which they can pass directly to a housing support officer. Staff are co-located so there's much more scope for brainstorming and getting things sorted out quickly."

The decision to merge primary care teams was taken back in December 2002. Inevitably, there were anxieties about the change among front-line staff. "Managers said they wanted to keep people informed as much as possible. But it was a difficult process, with lots of complicated negotiations between the three partner agencies."

As soon as Workman knew her team would be the pathfinder she arranged a team-building event at a local hotel. "It was a Saturday and everyone came. People were upfront about their concerns. Health staff were worried about a takeover from social care and the other way around."

But the change of management has also benefited nurses. "They said they wanted a visible manager. Previously, they were directly managed by the head of nursing."

Workman acknowledges that managing staff from different disciplines can be challenging. "You have to work very hard to achieve everyone's respect. It's being around and listening to their concerns and being prepared for difficult discussions."

Coming from a background in social care, Workman finds it can be hard to understand immediately the different professional perspectives on a problem. "It's been a steep learning curve and I admit I haven't always fully grasped the issues. I always say to people that they need to spell out the implications, particularly with regard to health and housing issues."


As time passes the team's understanding of other disciplines is growing and staff are able to make earlier referrals. "We generate work for each other as we become more aware of each other's roles. It means we can highlight problems early on."

Workman believes that a key element in the effectiveness of her team is the level of support provided by skilled administrators. "We have three high-level people doing business support. It is quite expensive, but it has succeeded expectations and freed up district nurses and social workers to do front-line work."

Fourteen months on the team has gelled, morale is high and Workman is enjoying her new role. "I wanted the job because it was a co-located team. I feel more effective because of the way we work in partnership. You can see the benefits in outcomes for people. I'm involved in all sorts of things across the borough, which makes the job all the more rewarding."

Curriculum vitae 
Name: Ann Workman. 
Job: Community partnership manager, Sedgefield  Primary Care Trust. 
Qualifications: Diploma in Social Work, MBA.
Last job: Commissioning services manager.
First job: Secretary. 

TOP TIPS

• Listen to concerns and discuss difficult issues.
• Let staff to spell out problems from their professional perspective.
• Be prepared to work hard to achieve respect. 

RUBBISH TIPS

• Keep a low profile and expect the team to work things out themselves.
• Skimp on admin - after all new technology means people do their own typing and filing anyway.
• Think that everyone can do each other's jobs.