I believe the recommendations are appropriate but lack detail about how MDT care should be structured and delivered, and a lack of focus on what the desired outcomes of an effective MDT should be. Similarly in relation to the symptoms that the MDT should seek to address, there is a lack of guidance on how the MDT should collaborate to address these symptoms. For example, what professions should be involved, what should each bring to the MDT, how should the MDT communicate and work together to address the symptom. The recommendations uses word like coordination, coordinated care and communication without defining what these mean and how they look in practice. My experience is that MDT care just happens but has not necessarily been planned to happen in line with what is known about effective MDT teams in MND or wider health care. It is important that the MND coordinators take on responsibility for this role, and I feel it is important that the MNDA invests in the education of these roles in relation to what good quality MDT care looks like, what the outcomes are, and how these can be measured and reported on. Just having on paper that you have present or access to a list of professions does not mean that those professionals as a group are delivering MDT care. There is a different between an MDT and MDT care delivery. I have experienced many barriers to HCPs being able to communicate effecitvely including lack of shared patient records, not updating the MDT with discussions/progression with decision making/changes in patients condition/updates about patients wishes and preferences. Communication breakdown is probably the biggest threat to good quality MDT care delivery.