Operationalising MDT streamlining through standards of care: a framework for specification and implementation

Multidisciplinary team meetings (MDTMs) are central to cancer treatment planning in the UK, but increasing caseloads, growing clinical complexity, and workforce constraints have raised concerns about the sustainability of a "discuss-every-case" model. National guidance in England now promotes MDT streamlining, using Standards of Care (SoCs) to stratify cases requiring full multidisciplinary discussion from those suitable for standardised pathways. However, there remains limited clarity on how SoCs should be specified and governed to ensure safety, consistency, and clinical accountability in routine practice. This mini-review synthesises national policy, emerging empirical literature on MDT streamlining, and evidence from complexity research to examine SoCs as a mechanism for operationalising MDT reform. We highlight that empirical evaluations of streamlining remain limited and heterogeneous, and that reported effects depend less on caseload reduction than on information readiness, organisational context, and explicit escalation criteria. Drawing on NHS England guidance, specialty recommendations from the British Association of Urological Surgeons (BAUS), and the Measure of case-Discussion Complexity (MeDiC), we present a structured framework to support SoC development. The framework specifies parameters across patient, pathology, and treatment domains (in line with the MeDiC tool), alongside explicit eligibility, exception, and escalation logic, and interfaces with governance requirements for triage, data completeness, and audit. By making decision boundaries transparent and multidimensional, this approach addresses key risks associated with oversimplification and inappropriate exclusion while preserving clinical judgement and patient-centred care. Structured approaches to SoC development provide a defensible foundation for focusing MDT discussion where it adds greatest value under increasing service pressures.