In a review of cancer multidisciplinary team (MDT) working published today, 10 November, we have identified opportunities to improve NHS cancer care through more effective collaborative working. The collaborating team of experts will now develop a practical toolkit to bring about a radical shift in cancer MDT working across the UK. 

The government’s National Cancer Plan for England committed to modernising cancer care and recognised the need to reform cancer MDT working to ensure patients receive the right expertise, at the right time, through the most appropriate mechanism, without unnecessary delays to their care pathway

The review identified that while multidisciplinary working is essential to provide high-quality cancer care, the current model is broken. Resource-intensive formal MDT meetings are often inefficient and not delivering timely care for patients. 

The RCR engaged with patients and professionals from across the UK to build consensus on what needs to change. These included clinicians working in radiology, oncology, surgery, nursing and pathology, the essential non-clinical staff who coordinate and administrate MDT working, representatives from the healthcare industry, and patients with lived experience of cancer care.  

Through this extensive engagement, the review identified opportunities to improve MDT working. It found that MDT meetings should focus on patients whose cases would most benefit from multidisciplinary input, such as those with rare and less common cancers. Meanwhile, patients with more routine cases should not have to wait until a weekly meeting to receive treatment recommendations. 

The review identified key opportunities for improvement:

• The right discussion at the right time. Speed up patient pathways by allowing routine cases to progress without discussion at a formal MDT meeting. Improve treatment quality and reduce variation by focusing specialist MDT capacity on patients with more complex cases and rarer cancers.  
• No decision about me without me: strengthening patient-centred recommendations. Improve treatment quality by ensuring that the patient’s preferences and wider psychosocial factors are considered when developing treatment recommendations. This reduces the risk of patients receiving recommendations that don’t work for them and therefore helps to speed up treatment.  
• Putting the ‘T’ back into MDT. Increase treatment quality and consistency by improving team efficiency through clearer leadership expectations, purposeful involvement and better-supported MDT teams. 
• Designing technology around MDT needs: enabling a digitally supported MDT model. Speed up patient pathways and reduce variation in care by defining clear expectations for MDT technology, enabling critical patient information and specialist expertise to move across providers, specialist MDTs, and regional networks.   

Putting these opportunities for change into action

Numerous attempts have been made to streamline MDT working in the past, but unfortunately, change has not stuck. Multidisciplinary team working will be increasingly essential as cancer care becomes more complex. However, they need to be improved to effectively enable and empower clinicians to use them as spaces to rethink service design, drive quality improvement, and generate care plans for complex patient cases. 

The MDT Improvement Toolkit will be published in spring 2027.    

Professor Sarah Coupland, President-Elect of the Royal College of Pathologists, said:  

"Patients benefit when multidisciplinary expertise reaches them promptly and in the right form, and MDT reform is key to making that happen. Pathologists currently spend considerable time in MDT meetings, so better-designed processes would also help clinicians work more efficiently. Digital pathology and better IT infrastructure would also increase the efficiency of MDT working." 

This review is part of a programme of collaborative working with the RCR including a roundtable in the summer attended by College President Dr Bernie Croal, which focused on addressing barriers to diagnostic AI implementation.  The roundtable identified several key barriers as well as recommendations which, if adopted, would help ensure national ambitions for the roll-out of proven diagnostic AI tools from 2027 are realised. These include:  

• Clearer oversight across specialties: AI tools are increasingly blurring NHS departmental lines of responsibility. NHS trusts and health boards should facilitate multispecialty AI implementation so diagnostic AI tools, wherever they are used, can be deployed safely, with confidence and with adequate oversight.  

• Clarity on responsibility and liability: Uncertainty around medical liability where AI is used remains a major concern for clinicians. Government should work with medical royal colleges to address uncertainty around responsibility and liability when AI is used in clinical practice. 

• An AI-ready system: AI readiness varies considerably between providers. Government should invest in AI readiness across all NHS settings, including supporting training for clinicians, to ensure equitable AI implementation.  

You can read the full report here.

College Past President Professor Mike Osborn joined a parliamentary roundtable in September led by the RCR and chaired by Clive Jones MP bringing together patient representatives, clinicians, cancer charities and policy experts to explore steps the Government and NHS can take to deliver on the ambitions and targets outlined in the National Cancer Plan for England. The discussion focused on how to diagnose more cancers earlier, deliver timely treatment and sustainably improve outcomes for patients in the context of rising pressure on diagnostic services.