The Necessity - and Challenge - and Promise - of MDTs
Chapter 1
Most healthcare professionals know what a Multidisciplinary Team Meeting (MDT) is and how it works, but for patients or their relatives it is a foreign concept. Mandated by the Department of Health in 2000 as a feature of NHS National Cancer Plan and part of broader shift in cancer care, Multidisciplinary Team Meetings (MDTs) – which now take place all across the health and social care sector – require a team of professionals from a variety of clinical disciplines and professional groups (in the case of cancer: surgeons, oncologists, diagnosticians, specialist nurses, and administrators) to come together each week to collaboratively plan the care of their patients.
Introduced to address discrepancies in the quality, coordination, and delivery of cancer care across the NHS, staff regard MDTs as a 'gold standard.' A fixture of the clinical working-week which recognises the complexities of cancer treatment and the imperatives of diverse expertise in managing it effectively. It is an intuitively sound concept, a collaborative model superior to the overdependence on sole practitioners which preceded it. Therefore, it is little wonder cancer patients take comfort from discovering the trajectory of their treatment will be determined by an entire group of specialists.
Even the very best ideas must brace for contact with reality, and today’s NHS is an increasingly inhospitable reality. Since inception, the Cancer Pathway has radically transformed the patients’ journey from what was once a lottery or crapshoot into a keenly measured and standardised process involving, for the most part, rapid access, assessment and diagnosis. However it has been a victim of its own success, an upside reflected in the downside. The clinical threshold for a referral is sufficiently low as to include patients with non-specific symptoms and a low likelihood of a cancer diagnosis.
Approximately nine out of ten patients referred do not have cancer – and GPs, who find themselves in the unenviable position of gatekeeping this access point with a paucity of resource while facing criticism for the consequences of late diagnoses, know they can get patients seen rapidly despite a low probability of cancer. Unsurprisingly, referrals have climbed roughly 5% year on year, a trend which shows no sign of abating, and as they have done so the duration of many MDT meetings has been extended to accommodate this growth.
The problem is one of congestion. Even if that congestion is itself a symptom of incapacities and pressures elsewhere in the system. Our next post will be on current realities and streamlining.
It is time to be Healthcareful®