In the NHS’s rush to do more with less there is an inevitable temptation to merge teams, or broaden the remit of existing teams. If clarity of aims - the core requirement for effective team working - is sacrificed, inefficiencies result.

Without clear team purpose, members are unable to achieve role clarity and the team is unable to negotiate its role with respect to other parts of the local service system.

Where a merger is not properly informed by a thorough analysis of demand and capacity, problems are exacerbated by team and personal overload, leading to demoralised staff.

Published this year, the Teamwork Within Mental Health Services in Ireland report highlighted that, alongside clear aims, good team working requires just enough people, with the right skill mix, and who are interdependent, to get the job done.

Where this interdependence is lacking, consider a network or other structures for peer support and intelligence sharing.

The team leader needs to support the team in managing its boundaries while not being so precious and inflexible that referrals are bounced around the local service system.

This requires that they defend and support space for the team to reflect on its work and its context, including the work of collateral teams.

In turn this requires that the team has usable information on how it is achieving its purpose.

Leadership at team level is particularly demanding.

The team leader needs both to face in, as a conduit for communication from the wider system, and out, representing the team and its work to the locality.

Team leaders are often in the position of delivering unpalatable messages and need to consider their own personal stance about the things the team is being asked to do.

Research shows that the effective leader is seen as advancing the interests of the group.

When team leaders are seen as the face of external management, they can be perceived by the team as being exactly the opposite.

At the same time, sitting on the team boundary, leaders have to contain the team’s most difficult emotions.

They can be the place where the team’s feelings of anger and anxiety are projected and they need their own support to recognise that these feelings are usually not personal, but come with the job.

Team leaders need to help evolve leadership capacity throughout the system, including patients and their supports.

Ensuring role clarity is key to people being able to step into their own authority and be maximally effective.

The team leader needs to have skills in change management and effective team leaders are crucial to helping teams through troubled times. But unless they have their own effective support it can be a lonely job.