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44 Teamwork is of crucial importance in its own right; its continued development will serve to break down the tribal barriers referred to earlier. Collaboration between professionals is the core of what we mean by teamwork. Many healthcare professionals will believe that they have always worked in teams, such that there is nothing new here. In the past, the `team', more often than not, consisted of individuals from only one group of professionals, with the most senior person being in charge and the rest following, like it or not. Such historical arrangements may have suited administrative convenience or the niceties of professional etiquette but they did not necessarily suit the patient.
45 Teamwork as a means of serving the patients implies a multi-professional team and a sharing of responsibility. The team leader may not necessarily be the most senior member of the group and, crucially, may not be a clinician, if the circumstances are such that some other professional should take the lead. Leadership is based on ability and function in the context, rather than some title or professional qualification. Moreover, teams must cross the boundaries of profession and discipline. We note the efforts on the part of professional bodies to promote multi-professional teamwork. The GMC, for example, in January 2000 issued guidance on teamwork in medicine. It is, however, a sign of how much things need to change, and singularly ironic, that such advice about professions working together is issued by a single professional group. Multi-professional teamwork needs multi-professional guidance and multi-professional leadership. Teamwork is the collective collaborative effort of all those concerned with the care of the patient. Patients do not belong to any one professional; they are the responsibility of all who take care of them.
46 We conclude as we began. The culture of healthcare, which so critically affects all other aspects of the service which patients receive, must develop and change. Fundamentally, this will be achieved through education, through learning new ways to work and through forging new links within and between professional groups. It is instructive to recall the words of Professor Lucian Leape during one of our seminars: `Culture is not amorphous, nor immutable; we are not powerless to change it. It is in some respects no more than the sum of the actions and attitudes of many individuals. Thus, if in some crucial areas of practice we can change the rules, the regulations and incentives, behaviour and, ultimately, attitudes will follow.' We agree. We now turn to a consideration of what the patient is entitled to expect from a changed NHS. We begin with respect and honesty.
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