INTRODUCTION: In the United Kingdom, it is the standard of care that treatment decisions in all new cases of head and neck cancer (HNC) are discussed at a multidisciplinary team meeting (MDT). The aim of this project was to gain a national perspective on the scope of current HNC treatment, compliance with national cancer pathway targets, and their influence on survival outcomes. METHODS: A multicentre, retrospective, national observational study of primary HNC patients was discussed at a specialist MDT between September and November 2021. RESULTS: Data on 1488 patients were included from 50 UK departments. The most common subsite was oropharynx (35.4%, 522), of which 61.7% (263) were HPV positive. Median time of referral to diagnosis, MDT decision to treatment, and referral to first definitive treatment in primary HNCs managed curatively were 37 (interquartile range [IQR] 22-57), 42 (IQR 29-65), and 74 (IQR 54-101) days, respectively. Compliance with the 28-day, 31-day, and 62-day targets were met in 32.8% (488), 33.3% (495), and 34.6% (515), respectively. On multivariate analysis, patients with urgent cancer referrals, T1-T2 stage disease, and not undergoing a general anaesthetic biopsy were associated with greater compliance with national pathway targets. CONCLUSION: This study highlights the majority of UK HNC patients are not meeting national pathway targets and delays are seen at all points in the HNC journey. Improving adherence with national best practice standards will contribute to reducing time to treatment for HNC.