Framework for Effective Cancer Management (FECM)
1. What was the issue/problem identified?
During a scoping workshop in 2019, it was identified that support and improvement for cancer MDTs was required to enable service and clinical teams to identify efficiencies and new ways of working to adapt to pressures and changes. Increasing numbers of cases were coming through MDTs requiring clinical review, and in 2019 the pandemic forced these groups to work remotely and meet online, most via MS Teams, which had a huge impact on the ways in which they worked.
There are upwards of 65 MDTs based across the four West of Scotland NHS Health Boards, which range in size from small site-specific MDTs which meet fortnightly or monthly, to large, regional MDTs which meet for 4 hours every week. Any model for supporting these teams needed to be adaptable to the varying size, needs and culture of each individual MDT.
2. What did you do?
A tool was identified by a clinical member of the Regional Cancer Advisory Board. This tool undertakes a 360° review of an MDT – via anonymous survey and observation by an independent external reviewer – the findings of which are both compiled into a report, and are then discussed with the aid of an independent facilitator. The aim of the discussion is to agree actions for addressing any challenges the MDT faces, as well as to note areas in which the MDT is succeeding.
The tool was developed by the University of Surrey, which worked with over 100 MDTs to design the process, and which then went through psychometric testing. In the West of Scotland, it was recognised that due to differences in operation between NHS England and NHS Scotland, a pilot should be undertaken to better understand the process and be sure it would work for all MDTs in place in the West of Scotland region. The tool was successfully piloted in four MDTs, and then went on to be rolled out across all cancer MDTs in the four Health Boards (NHS Greater Glasgow & Clyde, NHS Lanarkshire, NHS Ayrshire & Arran and NHS Forth Valley).
The rollout was undertaken, with involvement and oversight from the West of Scotland Cancer Network (WoSCAN). This way, actions were able to be owned and taken forward by the Boards who could support with Board-specific issues, and WoSCAN meanwhile were able to maintain an overview of key themes and trends to support planning and take forward any further learning and developments at the regional level.
MDTs were engaged via the regional cancer MCNs, and a rollout plan was designed which allowed time for MDTs to undertake the programme (roughly 6-8 weeks from start to the development of actions), with consideration given to those clinicians who sit on multiple MDTs to reduce burden and confusion.
3. What was the outcome?
There is an ongoing programme of development and support to MDTs, informed by outputs and findings from the MDT review process. This highlights numerous themes, including:
- The impact of changes introduced to how teams work and meet, as a result of the COVID-19 pandemic
- This included how team working was affected by remote working, and as such a “Guide to Teams Etiquette” was created as an appendix to the existing MDT Constitution and Operational Policy.
- The importance of regular business meetings to address the effective running of the MDT, as well as a team building opportunity
- Changes to referral process and outcomes reporting to ensure availability of information and reduce time spent in the meeting finding information or deferring cases
- Opportunities for training and development, including:
- how to improve skills for complex meeting management
- sharing the latest research and evidence
- how to involve trainees more effectively
- Job planning and clinical provision for increasingly complex cases, across specialties
- Equipment and technology for smoother meeting functionality
The following positive feedback came from a clinician who took part both as an MDT participant and as an observer during the peer review:
“Straightforward, non-intrusive process either being observed or being the observer, in the MDT-FIT programme.
Balanced feedback to encourage improvement and team discussions.
I am fully supportive of this development as it provides a clear pathway to enhance efficiency, streamline workflows and allow us all to work together in providing the best possible patient centred care.”
Breast MDT member, February 2025
A number of lessons and reflections have been made from the programme. This varied from appropriate administrative support through to opportunities for training the MDT members.
The programme benefited from having dedicated project management resource, which was necessary to cover the number of MDTs – including providing the necessary facilitation support – and to reduce any administrative burden on MDT Chairs.
It was frequently noted that many MDTs do not have the time and opportunity during the MDT meeting to discuss the needs and requirements of the MDT, which often led to frustrations, and therefore the opportunity to reflect with dedicated time and support was well received.
Across such a large spectrum of MDTs, even where similar problems were recorded, the actions and resolutions often varied due to differences in how MDTs work.
Additionally, for those members who took part as an Observer, the ability to review other MDTs was a learning opportunity and many appreciated the opportunity to see how things are done elsewhere.
Moreover, the external peer review, or “Observation”, also allowed for clinical assurance from a governance perspective that MDTs are operating in a safe and supportive way. Whilst one review is a snapshot of the MDTs’ practice, there is also the confidential feedback mechanism via the survey which allows any concerns to be raised.
Contact
Service Improvement Team, West of Scotland Cancer Network at ggc.woscan.generic@nhs.scot