Table 6 Key findings of the 2004 - 2007 Peer Review Programme of Upper Gastrointestinal Cancer services in English NHS acute trusts [12].

Referral pathways

55% of the networks had referral guidelines agreed for diagnostic referral to secondary care

49% of the networks had guidelines agreed for referrals from secondary to tertiary care.

Network structure

There were significant gaps across all cancer sites in provision of oncologists, pathologists, radiologists, palliative medicine consultants and clinical nurse specialists.

37% of networks had specialist surgical teams with a 24-hour on-call rota (i.e. contained a minimum of 3 surgeons). There was wide regional variation in this from 13% (East) to 60% (South).

MDT structure

Units and centres had established their core MDTs in almost 100% of networks. Cover arrangements for core members (in case of annual leave etc) were in place overall in 58% of centres and 44% of units.

46% of cancer centres and 33% of local units achieved the standard of core members attending half of the MDT meetings

Clinical Nurse Specialist provision

The number of clinical nurse specialists per MDT was 1.4 for centres and 0.85 for units.

There was no clinical nurse specialist cover in 14% of cancer centres and 31% of local units, problems with workload and cover were reported in more than 20 centres and 30 units.