To the Editor: In their editorial commenting on our viewpoint article on Team Care Arrangements (TCAs), Harris and colleagues acknowledge a number of problems with TCAs and a lack of evidence for their effectiveness. However, they state that “the idea of team care still has merit” and that although there is “ample room for improvement in the current process”, they “cannot agree with Hartigan et al’s radical prescription to replace TCAs with patient summaries”.1

This seriously misrepresents our article. We did not suggest that TCAs should be replaced by patient summaries. We stated: “There are many elements in the solution to this problem, but one of primary importance is the development of a comprehensive patient summary”.2

Among these elements could be the one suggested by Harris et al — registration of patients in a shared database. However, a shared database would avail little if the patient information contained therein is not sufficiently comprehensive to permit development of well considered treatment objectives and priorities.

The essential issue is whether TCAs are an improvement on the coordination that occurs under the traditional referral system. Coordination exists along a spectrum. At one end, it can be rigidly structured, with all participants having right of veto over action by any of the others. At the other end, it can be fluid and unstructured, with decisions over who should be involved in any particular management issue left to the good judgement of participants. By electing to impose on general practitioners a coordination model at the rigid end of this spectrum, the architects of TCAs appear to assume that GPs are usually unwilling, or cannot be bothered, to consult with other health professionals and must be made to do so. This is a massive assumption that demands very strong evidence. What is the evidence? And even if there were evidence, is coercion the answer?

There is no doubt that coordination in care of patients with chronic illness is important and that it can be improved. However, improvements must be based on evidence and be practical. TCAs are neither.

In reply: We accept the clarification by Hartigan and colleagues of their article’s intent,1 and agree with the importance of good-quality information in electronic databases, especially if the information is to be exchanged.

Unlike Hartigan et al, we do believe that Team Care Arrangements (TCAs) have some merit, as they provide structure for planned care and help coordinate access to multidisciplinary care provided over a period of time within the complexity of the current health system. However, they have not been very effective in developing trusting relationships and encouraging better communication between general practitioners and providers outside the practice because of a variety of systemic barriers. In our editorial, we suggested some alternative strategies.2

Although the paperwork and complexity of current requirements could be reduced, we cannot see that coercion is involved. Both patients and providers can choose to enter freely into TCAs and the requirements are for communication and consent, not for “right of veto over action”.