Understanding the infrastructure required to support multidisciplinary team working in primary care: November 2026

Introduction

The General Medical Services (GMS) 2018 contract set out a vision to expand multidisciplinary team (MDT) working in primary care across Scotland. While this model supported growth in the MDT workforce, progress has been inconsistent. There have been challenges related to infrastructure, workforce availability, and variation in implementation.

The Scottish Government commissioned the Primary Care Phased Investment Programme (PCPIP) which was led by Healthcare Improvement Scotland to improve the implementation of pharmacotherapy and community treatment and care (CTAC) services through investment and quality improvement (QI) support.

PCPIP was delivered over 18 months across four demonstrator sites: NHS Ayrshire & Arran, NHS Borders, a locality in Edinburgh City HSCP, and NHS Shetland.

The PCPIP final report identified a range of findings that informed the development of 13 recommendations. This resource focuses on the findings and recommendations relating to infrastructure. Read the final PCPIP report.

Aim

To explore how infrastructure influences MDT working in primary care settings using qualitative and QI data from the PCPIP evaluation.

Methodology

A mixed method approach was used to collect primary care data relevant to the expansion of the GMS contract with a strong focus on pharmacotherapy and CTAC.

Qualitative data was collected across demonstrator sites (October 2024–July 2025). A pragmatic, multi-method approach was used to recruit primary care staff, including interviews and focus groups (Table 1).

Data was analysed thematically to identify infrastructure-related barriers and enablers.
Demonstrator site teams also collected QI data to understand their systems and measure the impact of changes they were testing.

Table 1: Total number of staff in an interview or focus group.

Results

Physical infrastructure

Suitable accommodation required

Limited availability of space within GP practices, including clinic rooms, was frequently reported as a barrier to accommodating newly allocated MDT staff.

Hubs can alleviate accommodation constraints

There can be challenges associated with staff working across different locations. However, the findings suggest that pharmacotherapy hubs can support practices by undertaking core pharmacotherapy work remotely, enabling practice-based staff to focus on more complex care.

Digital infrastructure

Integrated digital systems required

Unconnected, outdated and inaccessible electronic systems were barriers to communication and the coordination of care. This was a key challenge when MDT staff were not physically located within the GP practice.

Accessible IT systems for all staff and health boards

Limited and inconsistent access to digital systems resulted in disrupted informational continuity of care, additional appointments for patients and increased workload for administrative staff.

Demonstrator sites with more coordinated systems developed dashboards, which facilitated efficient access to QI data.

Recommendations

• Ensure enabling conditions for effective MDT working
• Invest in IT systems and Outcome Focused Monitoring

Conclusions

Infrastructure development must progress alongside workforce planning and QI capability to support sustainable and coordinated primary care services. Scottish Government will use the findings and recommendations from the PCPIP final report to inform future policy development.