I feel that the NICE Guideline (NG42) does reflect my experience of working in the current MDT. I do complete all my assessments in the patients home as I feel you can gain a lot by seeing them at home. Often things can be hidden / missed during clinic appointments, and I find assessing within the home really does give a true picture to how someone is coping. It also helps to see the home so that as a team you can start thinking about the future and how equipment / adaptations may work. It helps to then be able to guide conversations as required.

I feel that the essential function of an MDT is captured within the Guidelines. I think the guidelines are very open to interpretation in terms of how MDTs should be run, which is why I think we see such a discrepancy across the country, and this is my experience of all Rare and Progressive Neuro conditions, not just MND.

I feel that the greatest challenges with the MDT approach is that different NHS trusts / organisations will be accountable for different services involved in the patients care. For example, for half of my caseload, the Palliative Care contract is with a Hospice, yet the other side in a different postcode are with an NHS trust. Patients in my caseload are often under different MND care centres depending on where they live. Another challenge I feel is to do with funding and who funds what. This isn’t necessarily an issue caused by poor MDT involvement but can cause frustration.

I often think that because so many services are involved, there is a good opportunity for joint visits, this would help with how many appointments patients have, ensure they don’t get appointment fatigue and prevent them from going over things again and again when new services become involved.