Why is it important?
Inflammatory Bowel Disease (IBD) is complex and fluctuating, and its physical and emotional effects can vary hugely from one person to another. This means that good multidisciplinary team (MDT) working is essential to deliver high-quality care for patients.
Every local area should have a dedicated IBD team. This specialist team should be able to support people with every aspect of their IBD care: from initial IBD assessment and diagnosis, to treatment, rapid care during flares, nutritional support, surgery if required, and holistic well-being.
In the 2023 IBD UK Benchmarking, 95% of IBD services reported holding frequent, monthly IBD multidisciplinary team (MDT) meetings. Despite this, a quarter of adults with IBD reported that they did not feel they were supported by a team of IBD specialists. This highlights the need for clearer communication between MDTs and patients. Firstly, patients should be made fully aware that an MDT is in place, overseeing their care. They should be provided with clear information about who is part of their team and what their roles are. IBD Services should also determine at least one specialist from the MDT to be responsible for each patient’s care, whose name and specialism should be clearly provided to the patient. If patients understand who their MDT is, and who is responsible for their care, they can feel more confident that they are being supported by a specialist team.
Core members should all have a special interest in IBD. For a catchment population of 250,000 people (the average for a district general hospital), the IBD multidisciplinary team should include:
- 2 whole time equivalent (WTE) Consultant Gastroenterologists
- 2 WTE Colorectal Surgeons
- 2.5 WTE Clinical Nurse Specialists with a special interest and a competency in IBD
- 1.5 WTE Clinical Nurse Specialist with a special interest and competency in stoma therapy and ileoanal pouch surgery
- 1 WTE Dietitian with specialist knowledge in IBD
- 0.6 WTE Expert Pharmacist in IBD
- 0.5 WTE HCPC-registered Psychologist with a special interest in gastroenterology
- 0.5 WTE MDT Co-ordinator to support IBD meetings, IBD database recording and audit
- 0.5 WTE Radiologist with a special interest in gastroenterology
- 1 named Histopathologist with a special interest in gastroenterology
Whilst there has been a positive increase in MDT staffing since 2019, the 2023 Benchmarking found that the percentage of services meeting recommendations remains low. Less than 25% of adult IBD services met resourcing recommendations for colorectal surgeons, dietitians, psychologists, IBD nurse specialists, and pharmacists.
Additionally, there are healthcare professionals who provide essential supporting services that should work alongside the core IBD team and have an IBD interest. These include:
- A Rheumatologist
- An Ophthalmologist
- A Dermatologist
- An Obstetrician
- Occupational Therapist
- Microbiologist
- A Hepatologist
- A Social Worker
- A Nutrition Support Team
- A Consultant Paediatrician
This is not an exhaustive list and may be subject to change as IBD management continues to change in complexity. Primary care should also be involved in supporting IBD care and be in contact with the MDT.
Paediatric and adolescent care needs additional consideration. Here, paediatric gastroenterologists, with specialist paediatric nursing and dietetic support, should work in a managed clinical network. This can help facilitate local shared care with adult gastroenterology colleagues and paediatricians with an interest in gastroenterology, particularly IBD. Each patient should have a named consultant paediatric gastroenterologist – even if their care is shared with a paediatrician in a general hospital.