Roles, Responsibilities, and Professional Boundaries Within the Team
Role clarity
Each member brings a defined scope of practice, a professional regulator, and a line of accountability. Role clarity means the team knows who assesses, who prescribes, who coordinates, who safeguards, and who is the patient's named contact. The chair manages process, the coordinator manages flow and actions, and clinical accountability stays with the treating professional.
Boundaries
Boundaries are not barriers; they protect patients from care delivered outside competence. Competence has three dimensions: training, current practice, and context (for example, a specialist skill used in an unfamiliar setting). Delegation is legitimate only when the delegate is competent, supervised as needed, and accepts the task. Trainees act within supervised competence, not under a vague 'team' umbrella.
Accountability
'The MDT decided' is never a substitute for a named accountable clinician. Record who agreed, who dissented, and who owns each action. Where professions disagree, escalate through agreed routes rather than averaging positions or letting the loudest voice prevail.
Patient and carer roles
Patients and carers are team members with expertise by experience; their involvement is not decoration. Consent, capacity, and confidentiality still apply to everything shared in the meeting.
Traps
Watch for role creep, seniority mistaken for cross-professional authority, and delegation without competence checks. Another trap is assuming the most senior doctor is accountable for every element of the plan.
Worked example
A specialist nurse is asked to authorise a treatment outside her competence because the consultant is unavailable. Correct response: decline to authorise, document the boundary, escalate to the on-call accountable clinician, and record the action and timing.