1. RESULTSOF UPPER GI MDT QUESTIONNAIRE Sukhbir Ubhi National Clinical Lead for Upper GI Cancer Services Collaborative 'Improvement Partnership'

2. Aims Obtain a “snapshot” view of the structure and function of Upper GI MDTs Identify organisational issues with MDTs Assess the use of “mapping” to identify problem areas Identify bottlenecks

4. Responses 57 Replies received 51 Upper GI MDTs are fully up and running 6 Upper GI MDTs are partially up and running

5. Frequency Of Upper GI MDT Meetings

6. Frequency That Consultant Surgeons Attend MDTs

7. Frequency That Medical Oncologists Attend MDTs

8. Frequency That Clinical Oncologists Attend MDTs

9. Frequency That MDT Clerks Attend MDTs

10. Frequency That Specialist Nurses Attend MDTs

11. Frequency That Histopathologists Attend MDTs

12. Frequency That Radiologists Attend MDTs

13. Frequency That Gastroenterologists Attend MDTs

14. Frequency That Palliative Care Representatives Attend MDTs

15. Attendance at MDTs

16. Major Organisational Problems With MDTS? 32 replied that they had major organisational problems including: No MDT co-ordinators No timetabled activity Limited or No dedicated accommodation or equipment Audit/data collection Obtaining notes/X-ray

17. Mapping Exercise For Upper GI Patient Journey 27out of 57 have already processed mapped with a 50% success rate 5 are currently being planned Difficulties encountered: - Complex pathway -Poor documentation/feedback of findings -Lack of action following process mapping -Hidden issues not "teased" out -No CSC person in post -No allocated time

18. "Bottlenecks" Primary Care –Referral pathway –Patients not going to GP with symptoms –Poor support for patients –GP not recognising alarm symptoms

19. "Bottlenecks" Radiology/Endoscopy –Booking –Capacity –CT Waiting Times –CT Staging –Access to PET scanning

20. "Bottlenecks" Delays to first diagnostic test due to referrals to Gastroenterology, A&E or Care of the Elderly Chemotherapy/Radiotherapy start dates Histology reporting Access to palliative care Insufficient time for surgery Bed availability HDU/POCCU/ITU No Upper GI nurse specialist

21. Summary Major Organisational issues with most MDTs Variable attendance of “key” personnel at MDTs Bottlenecks at every stage of the patient journey