How accurately do these recommendations reflect your experiences of working within an MDT?

The mandatory core team structure accurate reflects the MDT I have worked alongside for persons living with MND. Although, typically the allied health team, palliative care and key worker are community based, with the neurologist being clinic based. And although the person is regularly assessed, these assessments are less coordinated. For example, I am in contact with the person weekly and continually assess function and make changes to their equipment and housing needs timely as they arise, however neurology appointments are scheduled 6 monthly with limited input between these appointments and very limited liaison with the MDT. Additionally, I have had limited input from the palliative care team outside of what the person reports to me. These guidelines have highlighted some gaps in care and a more fragmented approach as to what the NICE guidelines recommend. 

How well do they capture the essential functions of multidisciplinary working?

The NICE guidelines have set out a comprehensive framework for multidisciplinary working and each persons role within the MDT. However, it doesn't take into consideration the practicality of 2-3 monthly MDT meetings, especially in consideration of both community based and clinic based MDTs working with the person with MND. Trying to get a comprehensive team of professionals together who all work different days, different hours and for different companies is quite a challenge, especially at a frequency of every 2-3 months. 

What do you consider to be the greatest challenges of applying the MDT approach in MND care?

In the community, the greatest challenge is coordinating communications and meetings with the MDT in a timely manner. The community based MDT typically comprises of the key contact (support coordinator), OT, PT and SP. Whereas the palliative team, GP and neurologist are usually clinic based and harder to get in contact with. Additionally, neurologists in my geographical location are already stretched so thin, therefore making it more difficult to get in contact with them. I have tried managing this by completing a short summary report of my findings to bring to their attention as I first assess the person and as changes in the persons function arises.