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Assessment of Upper GI MDT Functionality: Challenges and Bottlenecks in Patient Pathways

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This report presents the findings from a questionnaire designed to assess the structure and function of Upper Gastrointestinal Multidisciplinary Teams (MDTs) across the UK. A total of 57 responses were received, revealing that 51 MDTs are operational while 6 are partially functioning. Essential attendance rates of key personnel at MDT meetings were recorded, along with major organisational concerns such as lack of coordinators and inadequate resources. The study highlights significant bottlenecks in patient pathways, ranging from referral processes to access to critical care services.

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Assessment of Upper GI MDT Functionality: Challenges and Bottlenecks in Patient Pathways

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  1. RESULTSOF UPPER GIMDT 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

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

  4. Frequency Of Upper GIMDT Meetings

  5. Frequency That Consultant Surgeons Attend MDTs

  6. Frequency That Medical OncologistsAttend MDTs

  7. Frequency That Clinical Oncologists Attend MDTs

  8. Frequency That MDT Clerks Attend MDTs

  9. Frequency That Specialist NursesAttend MDTs

  10. Frequency That HistopathologistsAttend MDTs

  11. Frequency That RadiologistsAttend MDTs

  12. Frequency That GastroenterologistsAttend MDTs

  13. Frequency That Palliative CareRepresentatives Attend MDTs

  14. Attendance at MDTs

  15. 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

  16. 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

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

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

  19. "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

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

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