Abstract: Consultant site specialisation in clinical oncology is accompanying increased decision making within a multi-disciplinary forum. Using retrospective audit in the periods before and after site specialisation, this study examines patterns of care and compliance with NICE chemotherapy recommendations and local radiotherapy protocols. A retrospective review of patients` notes was conducted in a London teaching hospital tertiary cancer centre. The outcome measures assessed were patient characteristics, waiting times for radiotherapy and compliance with the newly instituted guidelines in year 2. Three hundred NSCLC patients received radiotherapy to their primary lung lesion; 127, patients year 1 (1.1.00-31.12.00) and 163, patients year 2 (1.8.01-31.7.02). The number of patients treated increased by 28% from year 1 to year 2. The median waiting time for radiotherapy increased significantly from 13.5 to 27 days (p = 0.0237). In year 2, 130 (80%) of patients were treated according to the new radiotherapy guidelines. 92% (35 of 38) of chemotherapy regimes were prescribed within the guidelines in year 2. Consultant site specialisation resulted in significantly greater uniformity of care with excellent compliance to radiotherapy and chemotherapy guidelines. Increased consistency of treatment had a positive impact on patients` care and treatment outcome. However, the increased waiting times may compromise tumour curability and cost benefit.