From meeting-centric MDTs to continuous multidisciplinary care
· Gena Health Team
The Royal College of Radiologists (RCR), working with Macmillan Cancer Support, has published its Review of Opportunities for Cancer MDT Modernisation. Commissioned by the Department of Health and Social Care, it is one of the clearest statements yet of how multidisciplinary team (MDT) working in cancer care needs to evolve as demand rises and oncology becomes more complex.
This article summarises the report's findings, its eight actions for the next phase of MDT modernisation, and what they mean for oncology teams and the technology that supports them.
Why cancer MDTs need to change
MDT working has been the cornerstone of UK cancer care since the 1995 Calman-Hine report. Over time, however, MDT working has become synonymous with the formal MDT meeting, and that meeting is now the default mechanism for progressing care, including for routine and protocolised cases.
The scale of the pressure is significant:
UK cancer diagnoses are projected to exceed half a million annually by 2040.
Formal MDT meetings can last several hours and involve dozens of senior clinicians, while individual patient discussions often last only a few minutes.
Repeat discussion of patients across multiple meetings is common, usually because key information is unavailable.
NHS England published MDT streamlining guidance in 2020, yet a 2024/25 survey found only 13% of respondents reported full implementation.
The review's conclusion is direct: not every patient requires discussion by a full MDT, and the current approach is not sustainable in the face of rising demand. MDTs need a more proportionate model in which patients receive the right expertise, at the right time, without unnecessary delay.
The right discussion at the right time
The first theme of the report is about focusing collective expertise where it changes care. Formal meetings should be reserved for patients with diagnostic uncertainty, competing or complex treatment options, rare and less common cancers, and other situations where multidisciplinary input adds the most value.
To support this, the report commits to two actions:
Tumour-specific National Cancer Streamlining Protocols, developed with NHS England's Getting It Right First Time (GIRFT) team, defining when formal MDT discussion is required.
Flexible models of MDT working, with clear criteria, governance, accountability and audit arrangements, so appropriate cases can progress safely outside the formal meeting.
The review is explicit that this is not about lower standards for routine cases. National Cancer Streamlining Protocols will bring together existing resources, such as NICE guidance and tumour-specific protocols, into a consistent and accessible set of guidance, promoting existing good practice rather than creating entirely new standards. Where patients progress without formal discussion, clear governance, accountability frameworks and audit trails are required to keep care safe, transparent and accountable.
Done well, the report argues this reduces repeat discussions, avoids the delays of waiting for the next scheduled meeting, and releases specialist capacity for detailed discussion of rare cancers and atypical presentations, supporting faster treatment initiation and improved performance against Cancer Waiting Time standards.
No decision about me without me
The second theme is about strengthening patient-centred treatment recommendations. The report is careful to position the MDT as developing recommendations for patients, rather than making decisions on their behalf.
That means treatment recommendations need to reflect patient preferences and wider psychosocial factors alongside clinical findings. The review commits to defining, testing and supporting practical mechanisms for bringing the patient voice into recommendation development, so that the people who know the patient best contribute to the discussion.
The review found that most MDT discussions focus predominantly on clinical and diagnostic information, without consistent access to patient circumstances, social support networks, individual preferences and psychological factors. Recommendations that miss these wider factors can prove unacceptable or impractical after discussion, delaying agreement on a treatment plan. The report points to approaches such as structured patient-perspective summaries and better documentation within referrals, developed with lived-experience representatives and Clinical Nurse Specialists, and notes that shared decision-making should include consideration of clinical trial opportunities where relevant.
Putting the 'T' back into MDT
The third theme concerns leadership and teamworking. The review found that not all clinicians attending MDT meetings actively participate, often because their input is not required, and that effective multidisciplinary working depends on more than attendance.
The report commits to developing a nationally endorsed model for MDT leadership and teamworking, defining the roles, behaviours and organisational enablers required for high-quality MDT working across both formal meetings and emerging flexible models.
The review found considerable variation in MDT leadership, psychological safety, constructive challenge and shared accountability. Many MDT leaders take on the role without formal leadership training or protected time in their job plans, which contributes to inconsistent care within and between cancer services. The proposed national model covers consistent role descriptions, leadership development opportunities and job planning, so that leadership roles are recognised and valued rather than acquired by default.
The right information at the right time
Better decisions depend on better information. The review heard repeatedly that MDT discussions are deferred or repeated because referral information is incomplete, and that information is often assembled manually from fragmented systems.
In practice, referrals are made through a patchwork of forms, emails and local processes, with wide variation in the information provided. MDTs frequently lack the clinical, diagnostic and patient information needed on referral, leading to repeated requests for missing information, duplication of effort, and patients deferred to later meetings while they wait.
The report commits to:
Nationally agreed minimum datasets for MDT referrals, tailored to tumour type and specialist MDT requirements.
A nationally endorsed approach to MDT referrals, supported by agreed information standards and interoperability requirements, so referral information moves consistently between providers.
Designing technology around MDT needs
The report is unusually clear about the role of technology. It describes fragmented systems, duplicate data entry and time-consuming manual preparation of patient information as core obstacles, and argues that interoperability and workflow automation should be treated as core infrastructure rather than optional extras.
Its two technology actions are:
Defining core national MDT technology capabilities, information standards and interoperability requirements, and signalling them to market.
Promoting collaborative approaches to technology procurement and implementation, so providers can choose systems that support inter-provider MDT working.
The review also looks beyond single providers. Technology should enable critical patient information and specialist expertise to move across providers, specialist MDTs and regional networks, including models such as Expert MDT Advisory Groups, where specialist recommendations inform local discussions without patients travelling between centres.
Crucially, the review says modern MDT technology should support the full pathway, not just the meeting: referral, preparation, discussion, documentation and the actions that follow.
Measuring what matters
The final theme is evaluation. The report commits to a consistent approach to assessing MDT effectiveness, covering formal meetings, wider multidisciplinary activity and patient and service outcomes, so the impact of reform can be measured over time and effective practice can spread.
What this means for oncology teams
For Gena, the report closely reflects what we hear from the oncology teams we work with.
Three priorities stand out:
Complete case preparation: the clinical context needs to be assembled before discussion, so meetings start with the information needed to make a recommendation.
Patient context alongside clinical context: preferences and psychosocial factors need to travel with the case, not sit outside it.
Information that moves: specialist expertise and patient data need to flow across providers, specialist MDTs and regional networks without manual reassembly.
These are our observations as a company working in this space, and they align with the direction the report sets: multidisciplinary care organised as a continuous, digitally supported workflow around the patient, with the formal meeting reserved for the moments where collective expertise adds the most value.
The implementation gap is the real test
The report is candid that ambition is not the problem. The 13% implementation figure for the 2020 guidance shows how hard it is to translate national direction into local practice. The RCR and Macmillan plan to deliver the key actions over the next six months and launch an MDT Improvement Toolkit in spring 2027, and they are explicit that services should not wait: many are already testing new approaches, and that momentum should continue.The opportunity now is to turn a widely supported direction into workflows that hold up in real clinical environments. That is where MDT modernisation will release clinical capacity, reduce unwarranted variation and give patients faster access to the right expertise.
The report sets out eights key actions set out below:
Tumour-specific protocols defining when formal MDT discussion is required.
More flexible MDT working, with clear governance, accountability and audit.
Treatment recommendations that reflect patient preferences and psychosocial circumstances.
A nationally endorsed model for MDT leadership and teamwork.
National referral standards and minimum datasets, so teams have the information they need.
Core technology requirements, including interoperability and information sharing.
Collaborative approaches to buying and implementing MDT technology.
Consistent measures of MDT effectiveness, covering wider team activity and patient and service outcomes.
The opportunity now is to turn a widely supported direction into workflows that hold up in real clinical environments. That is where MDT modernisation will release clinical capacity, reduce unwarranted variation and give patients faster access to the right expertise.Source: Royal College of Radiologists, Review of Opportunities for Cancer MDT Modernisation, November 2026.