Published today in Clinical Oncology, new research sets out the challenges and recommendations to support UK neuro-oncologists working single-handedly or in small centres. Read the full article here.

Date Published: July 2025
Authors: Dr Morag Brothwell, Andrew Wright, Dr Nicky Huskens, Prof. Catherine McBain

Overview

One in ten neuro-oncologists currently works without a neuro-oncology colleague in their hospital, also known as single-handed neuro-oncology practice. Published in the scientific journal Clinical Oncology today, a new national study for the first time looks at the impact of single-handed practice in oncology, focussing on the implications for brain tumour services, patients and their families.

Led by Tessa Jowell Fellow Morag Brothwell (whose Fellowship was funded by the NIHR and the Tessa Jowell Foundation) and facilitated by the Tessa Jowell Brain Cancer Mission, this research show that single-handed neuro-oncology practice remains a widespread and under-addressed issue in the UK. The study, based on 35 in-depth interviews with UK-based neuro-oncologists, highlights how single-handed practice has implications for clinician wellbeing, patient access to care and research, and long-term service resilience.

Why This Matters

Neuro-oncology services in the NHS are organised into 29 regional multidisciplinary team (MDT) networks, covering 52 hospitals. However, within this structure, significant disparities exist in team size and service configuration.

The research shows that:

• 14 of 129 (11%) neuro-oncologist posts are single-handed, including one vacancy (see right)
• These posts are distributed across MDT networks of varying sizes and in five UK regions/nations: Scotland, plus Midlands, East, South East, and South West of England.
• Single-handed oncologists have lower access to peer review, annual leave, and MDT support 
• Clinical trial access is considerably lower in smaller teams

This represents a potential challenge to delivering equitable care to patients with a brain tumour across the UK, with implications for patient outcomes and clinician retention.

Key Challenges Identified

1. Practitioner Wellbeing and Service Sustainability

Single-handed and dual-handed practitioners reported isolated and unsustainable working practices during interviews, with a potential impact on practitioner wellbeing. Key challenges included:

• Annual Leave Constraints: 60 percent of single-handed oncologists were unable to take more than one week of leave without interruption (see right). Some had to work during leave periods or cancel leave due to service pressures.

“Here it was horrible. I couldn’t take any leave… It was not possible because I was my own. Things are getting better now [we have a second oncologist]”  – previously single-handed oncologist.

• Peer Review Gaps: Peer review of radiotherapy planning, recommended by the Royal College of Radiologists (RCR), was not always feasible.
• Large role scope: Single-handed oncologists frequently cover more than two tumour sites, more than the RCR recommendations, reducing their ability to sub-specialise and maintain clinical depth.

“It is quite a lot of siloed working… Mental health and wellbeing is very low down or not even on the priority list of the Trust” — single-handed neuro-oncologist

2. Research Access and Multidisciplinary Support

Clinical innovation and quality of care are being unevenly distributed.

• Clinical Trials: Every multi-handed centre had an active neuro-oncology trial, with an average of 5 open per centre. In contrast, four of seven single-handed oncologists and eight of twelve dual-handed oncologists reported no trial availability in their centre – with less than one trial available on average per centre (see below)
• MDT Service Gaps: Key disciplines like neuropsychology and neurology with a neuro-oncology focus were significantly less accessible. Only six of nineteen single- or dual-handed centres had access to specialist neurology. Only one had access to neuropsychology, compared with seven of thirteen multi-handed centres.
• Rehabilitation Services: Allied health professional support, including speech and language therapy, remains inconsistent across all centre types.

3. Systemic Pressures Unique to Neuro-Oncology

While single-handedness may occur in other cancer types, its effects are particularly acute in neuro-oncology.

• High Complexity and Urgency: Brain tumours such as glioblastoma often require urgent treatment decisions. Single-handed centres cannot easily delay care or absorb fluctuations in demand.
• Disproportionate Workload: Neuro-oncologists are increasingly called upon to manage stereotactic radiosurgery and brain metastases for patients under the care of other oncologists, creating workload imbalances.
• Recruitment Challenges: The perception that neuro-oncology is technically and emotionally demanding may limit the ability of smaller centres to attract staff, although recent posts have shown promising competition.

“Looking at small centres, I think the greatest challenge is that we do cover a lot more tumour sites than what’s recommended by the RCR, which poses a risk as to how you can keep up to date” – dual-handed neuro-oncologist

What do these findings mean for patients with a brain tumour?

Our findings suggest that single-handed neuro-oncology practice may impact neuro-oncologists’ wellbeing, access to professional advice and peer review, while also being associated with lower patient access to clinical trials and other specialties such as psychology and rehabilitation.

While all interviewees were working tirelessly to ensure the highest standard of care for patients, these challenges, particularly acute in neuro-oncology, could impact the long term sustainability of smaller neuro-oncology services. To ensure some patients do not have to travel hours to access care in larger centres, it is therefore crucial that the entire clinical community works to support single-handed practitioners. Below, we set out several actionable recommendations to achieve this.

Recommendations

Recommendations in the short-term: there are a number of immediate steps that can be taken locally and nationally to support the wellbeing of single-handed practitioners and ensure sustainable neuro-oncology services:

1. Establish local mentoring/cover: several centres had set up close relationships with neighbouring centres to facilitate advice, mentoring and annual leave cover, reducing any possible sense of professional isolation among single-handed practitioners – all centres should establish this;
2. Establish a national online education platform to discuss rare/difficult cases, currently in set-up by the Tessa Jowell Academy, used as a way of providing education, support and updates to oncologists in smaller centres;
3. Establish a single-handed/small centre oncologists network: single-handed oncologists and those working in smaller teams need opportunities to network and meet colleagues in similar situations to share solutions and best practice and offer support with challenging situations.

Recommendation in the medium/long term: several centres have taken steps to move away from single-handed practice or reduce the impact on patients and practitioners.

4. All networks with a single-handed oncologist should establish plans to reduce the impact of this practice on practitioners and patients. While each service works differently, there are multiple ways in which Trusts and leaders within wider MDT networks can work to relieve pressure on single-handed services:
   1. Recruiting a second neuro-oncologist, to balance work load and improve resilience
   2. Joint appointments of single-handed oncologists at a nearby multi-handed centre to ensure networking and annual leave cover (although noting the time constraints at larger centres reported by respondents)
   3. Merging a single-handed service into nearby multi-handed centre and establishing a remote chemotherapy service to ensure continued patient access across large geographical areas.

Recommendations for the wider neuro-oncology community:

5. Improve trial finders and infrastructure to boost trial readiness in every UK neuro-oncology centre. All interviewees highlighted that finding information about clinical trials, and then having the time or resources to open trials, was challenging, and this was particularly the case for single-handed practitioners. Lack of dedicated time and a high clinical workload also limit capacity for trial involvement.

Conclusions

Supporting single-handed oncologists in the UK will be crucial to ensuring a sustainable neuro-oncology workforce across the country. Many of the challenges mentioned above will impact practitioners’ wellbeing, increasing risk of burnout and reducing the long-term resilience and sustainability of services. Encouraging and supporting networking among single-handed practitioners could also benefit patients, by ensuring more there is more input into clinical decisions and learning from the latest developments in neuro-oncology.

This project suggests that the challenges of single-handedness are particularly acute in neuro-oncology; it is hence likely that action in neuro-oncology would have a particularly notable effect, but could also be used as a model for other cancers who face similar challenges.

Key Definitions

Multidisciplinary team – A multidisciplinary team (MDT) refers to a group of professionals involved in a patient’s care, with different disciplines being represented in the weekly team meetings to discuss patient cases. This team can involve more than one centre: an MDT network, which is usually dependent on the geographic areas covered by the neurosurgical unit.

Centre is a hospital(s) where a neuro-oncologist is employed. This is unrelated to the 30 neuro-oncology centres eligible for assessment as part of the Tessa Jowell Centre of Excellence programmes; for the purpose of this report, these are referred to as MDT networks.

Neuro-oncologist can be defined as any clinical or medical oncologist employed by the NHS to treat tumours of the central nervous system, including cerebral metastases, and can practice independently. Single-handed oncologists are those with no other neuro-oncologist working in their hospital or department, while dual-handed have one other neuro-oncologist colleague and multi-handed have two or more colleagues.

Tumour site refers to the anatomical tumour site covered in an oncologist’s workplan, such as brain tumours (the focus of neuro-oncology), colorectal or breast