Jaspal Phull Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Cancer Service

MDT considered the gold standard since introduced in 1995 Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Cancer Service Cancer Research UK goal - reach 75% people surviving their cancer for 10y or more by 2034 MDT considered the gold standard since introduced in 1995 MDT may not have adapted to cope with increased demand CRUK motivated to streamline MDTs to support the increased demand Mean length of MDT discussion per case is 3.2 minutes, meetings can last up to 5 hours Surveys reported some patients could be discussed outside the full MDT Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Cancer Service

Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Cancer Service Recommendation 1 Triage patients to follow protocols outside the full MDT NICE and SIGN guidelines CA or SCN should develop their own protocol based on central recommendations Regular review

Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Cancer Service Recommendation 2 MDTs for protocolised approach tumour types could have a pre-MDT triage meeting Implementing and auditing these should be within the MDT framework in an operational meeting

Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Cancer Service Recommendation 3 National requirements for individual minimum attendance should be reviewed and amended where necessary Emphasis on requiring all specialties are present at the MDT meeting NHSE should run a series of pilots to assess the optimal % attendance National guidance changed based on these pilots

Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Cancer Service Recommendation 4 UK health services should develop national proforma templates MDTs should require all incoming cases and referrals to have a completed proforma with all information ready before discussion The MDT should have the power to bypass this requirement in exceptional circumstances Patient demographics Diagnostic information Fitness, co-morbidity, history of previous malignancy Results from a HNA Patient’s preferences if known Rationale for requiring MDT discussion Whether there are known protocols for the specific tumour site Whether the patient if suitable for relevant clinical trials

Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Cancer Service Recommendation 5 MDTs should use a database or proforma to enable documentation of recommendation in real time Otherwise a named clinician to review all outcomes Hospital Trusts should ensure that MDTs are given sufficient resource to do this

Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Cancer Service Recommendation 6 Each MDT should ensure that they have mortality and morbidity process to ensure all adverse outcomes can be discussed These discussions by the whole MDT to support learning Recommended this takes place quarterly or biannually in an operational meeting Time for this should be within job plans Oversight from national MDT oversight programmes