Abstract The present study represents a comprehensive retrospective review of endocarditis in a large district general hospital since the inception of a formalised policy involving collaborative management a decade ago. The principle was to involve a recognised team of cardiologists, specialists in infectious disease and microbiologists in the treatment of the disease from the moment of its diagnosis. The pattern of infection has not altered in terms of prevalent organisms and valves infected since the change in management policy. There has, however, been a significant decline in the mortality, from 34 to 24% for all patients with endocarditis. Amongst those referred for collaborative management, the mortality has fallen to 6%. The single greatest improvement is a reduction in the number of patients dying of heart failure, the number of patients developing systemic emboli or requiring prosthetic valve replacement remaining unchanged. The results indicate that early referral to, and treatment by, a multidisciplinary team can significantly reduce the mortality from bacterial endocarditis.