At the turn of the millennium, the NHS made a bold bet. Every new cancer diagnosis would be reviewed by a team of specialists rather than left to one clinician’s judgement. That bet became the Multi-Disciplinary Team (MDT) and it has shaped cancer care well beyond the UK, influencing the US Tumour Boards and comparable models across Europe and Asia.
A meeting built for a different era
In over 25 years, caseloads have grown significantly, due to an ageing population, rising incidence, expanded screening and a two-week-wait pathway that moves patients in faster than teams can absorb them. Sessions now often run four hours, with 70 to 90 cases on the list. One clinician in published research described finishing at 19:00 after a full day of clinics and asked, “Would you want to be number 70?”
That question highlights a real clinical risk: observational research shows that information quality, team contribution and depth of discussion all decline as a meeting goes on. This means that a patient’s position on the agenda can influence the quality of the recommendation they receive.
The EPR is not the answer
The instinctive answer to this situation might be to build MDT functionality into existing electronic patient records, but this is unlikely to deliver what teams need. EPRs were never designed around MDT workflows, and regional MDTs often span several Trusts running different platforms that don’t communicate with one another. Full integration or replacement is slow, costly and disruptive and even then much of the clinical picture sits outside the record altogether: GP record, external imaging reports, community letters and blood results that don’t fit neatly into structured fields. Years of investment could still leave teams without what they need on the day.
What can be done without waiting for an EPR overhaul?
Modernising the MDT doesn’t need an IT revolution. Targeted workflows that address where meetings actually break down can make all the difference:
Flag missing results early. Data gaps such as absent imaging, outstanding pathology and incomplete workups are the leading cause of case deferral. Alerting teams before the meeting protects everyone’s preparation time.
Standardised case summaries. Pulling information from multiple sources into one consistent format removes the lengthy preamble that opens each case.
Smarter agenda ordering. Sequencing by clinical complexity and urgency, not referral date, puts the hardest decisions in front of the freshest minds.
Asynchronous input. Specialists can contribute structured assessments in advance, so the voice that might change a decision isn’t lost because someone couldn’t attend that afternoon. Cloud-based MDT tools in digestive tract cancer have already shown gains in coverage and guideline compliance.
The patient’s voice. Research shows clinicians value patient preferences, yet referral forms and meeting structures rarely capture them. Digital tools can carry what patients have already said into the room, without replacing the consultation.
The Royal College of Radiologists’ MDT review expected spring 2027 will constitute a genuine turning point. The core idea behind the MDT, that pooled specialist expertise applied consistently to every patient beats any individual working alone, has lost none of its strength. However, the volume of work around it has changed and the tools to handle that volume exist today, they just need to be implemented correctly.
At Salutare, that is the problem we are working on: helping MDTs spend less time on administration and more time on the decisions that matter to patients.
References
Soukup T, Murtagh G, Lamb B, Green J, Sevdalis N. Degrees of multidisciplinarity underpinning care planning for patients with cancer in weekly multidisciplinary team meetings: Conversation analysis. J Multidiscip Healthc. 2021;14:411-424. doi:10.2147/jmdh.s270394
Soukup T, Gandamihardja TAK, McInerney S, Green JSA, Sevdalis N. Do multidisciplinary cancer care teams suffer decision-making fatigue: an observational, longitudinal team improvement study. BMJ Open. 2019;9(5):e027303. doi:10.1136/bmjopen-2018-027303
Department of Health and Social Care. National Cancer Plan for England. GOV.UK. Available from: https://www.gov.uk/government/publications/national-cancer-plan-for-england
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