The advent of novel anti-fibrotic therapies and the introduction of specialist, commissioned Interstitial Lung Disease (ILD) centres, has led to an increased workload for Multidisciplinary Team (MDT) meetings. We set out to survey specialist UK centres to gain a better understanding of their organisational processes and associated challenges.
Methods Between August and December 2015 we conducted an online survey of all 23 NHS England commissioned ILD centres, plus 5 specialist ILD centres in Scotland, Wales and Northern Island. The survey was sent to the clinical lead of each centre. A total of 20 questions assessed the workforce composition and frequency of meetings. Their workload was also evaluated and we asked them to identify areas that required improvement.
Results 26 out of 28 centres responded.
MDTs are coordinated by the ILD lead consultant (57%) or a medical secretary (26%), with only 17% directed by a MDT coordinator.
Peripheral hospitals participate in MDTs in 78% of centres; in person, via video-link or paper referrals; however, the majority of discussed patients are reviewed at the specialist centre.
MDTs are typically held weekly, lasting 1 to 2 hours, with 10 to 20 patients discussed. 26% of MDTs discuss all new referrals, 87% discuss all patients considered for anti-fibrotic therapy, whilst only 22% discuss all patients considered for immunosuppressive therapy (aside from oral steroids).
All respondents agreed that the available MDT time was insufficient. The most common reasons were cited as; lack of dedicated MDT funding (83%), lack of sufficient respiratory radiologist consultant time (78%) and lack of dedicated administrative support (61%).
In 96% of cases there is no local tariff in place to fund MDT discussion and all respondents agreed that a dedicated tariff would improve MDT provision.
92% of centres enrol MDT patients into clinical trials.
Conclusion Specialist ILD MDTs are able to concentrate a high level of expertise and allow patients access to vital clinical trials. They are, however, under considerable strain due to lack of funding and administrative support. A dedicated funding stream for this specialist service would be beneficial.
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