Go with the flow: the changing pathways in Urology CATS

1. Urology Clinical Assessment & Treatment Service UROLOGY CATS Go with the flow: the changing pathways in Urology CATS

2. “There comes a time in life when the doctor stops feeling yer bollocks, and starts feeling up yer arse.” (B Connolly, CBE)

3. Urology CATS- Objective • Primary care led service with integral Consultant support and leadership • Commissioned by STAHCOM to manage all urology referrals within St Albans & Harpenden • Aim to retain at least 65% of cases in primary care • Improve care pathways for patients

4. Clinics • Based at The Elms Medical Practice, Harpenden • Paper triage • Clinics: Wed, Thurs, Fri • Consultant and GPSI clinics • Referrals: post, fax or electronic by e-mail • Patients offered appt within 2 to 3 weeks

5. Clinical team- GPSI • Julian Smith • GP at The Elms Medical Practice • Clinical Lead • Responsible for running the service and reporting to the PCT • Dr Dylan Phillips • Contract Lead • Training • Diploma in Urology (Middlesex University) • Clinic based • Workshops • Ongoing assessments and examinations

6. Clinical Team- Consultants • Mr Jim Adshead • Special interest in prostate disorders, UTIs, stone disease, renal disease, paediatric (East & North Hertfordshire NHS Trust) • Mr Asher Alam • Special interest in reconstructive, oncology, female urology (Luton & Dunstable Hospital NHS Foundation Trust) • Mr Manoah Pancharatnam • Special interest in prostatic disease, andrology, paediatric urology (West Herts Hospitals NHS Trust)

8. Clinical Referrals/ Pathways • LUTS (BPH) • Prior to clinic • PSA (GP) • U&Es (GP) • MSU (GP) • IPSS • Bladder chart • Flow rate with bladder scan (Nurse led, at The Elms Medical Practice) • During/after clinic • Urological assessment • Treatment options • Follow up in CATS or may need further investigation in secondary care • Direct referral options into secondary care

9. Clinical Referrals/ Pathways • Stones • Prior to clinic • Blood tests (calcium, urate etc) • Renal ultrasound scan if clinically indicated from triage • During or after clinic • Urological assessment • Low dose CT KUB or CT urogram • Direct referral to secondary care for lithotripsy

10. Clinical Referrals/ Pathways • Scrotology • Prior to clinic • Small parts ultrasound scan if clinically indicated from triage • During clinic • Ultrasound scan (from mid October 2008) • Aspiration

11. Clinical Referrals/ Pathway • Other • Minor ops under LA • Discussion about current surgical options • Secondary Care Referrals • Via Patient Choice Team (STARDOC) • Direct booking access onto theatre lists - e.g. day case cystoscopy, TRUS biopsy

12. Benefits of this Service • For Patients • Improved waiting times • USS prior or at same appt by consultant/GPSI if needed • Improved care pathways • Patient choice re secondary care provider • Continuity of care • For Commisioners • Vertical integration with secondary care • Post op f/u retained in CATS

13. Patient Satisfaction Survey • 100% very satisfied with the service

14. Future • Increase pathways and further connections • Provide more services within clinics • Cystoscopy