Go with the flow: the changing Go with the flow: the changing pathways in Urology CATSpathways in Urology CATS

Urology Clinical Assessment & Treatment Service

UROLOGY CATS

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

Urology CATS- ObjectiveUrology CATS- Objective

Primary care led service with integral Primary care led service with integral Consultant support and leadershipConsultant support and leadership

Commissioned by STAHCOM to manage Commissioned by STAHCOM to manage all urology referrals within St Albans & all urology referrals within St Albans & HarpendenHarpenden

Aim to retain at least 65% of cases in Aim to retain at least 65% of cases in primary careprimary care

Improve care pathways for patientsImprove care pathways for patients

ClinicsClinics

Based at The Elms Medical Practice, Based at The Elms Medical Practice, HarpendenHarpenden

Paper triage Paper triage Clinics: Wed, Thurs, Fri Clinics: Wed, Thurs, Fri Consultant and GPSI clinics Consultant and GPSI clinics Referrals: post, fax or electronic by e-mailReferrals: post, fax or electronic by e-mail Patients offered appt within 2 to 3 weeksPatients offered appt within 2 to 3 weeks

Clinical team- GPSIClinical team- GPSI Julian Smith Julian Smith

GP at The Elms Medical PracticeGP at The Elms Medical Practice Clinical LeadClinical Lead Responsible for running the service and reporting to the PCTResponsible for running the service and reporting to the PCT

Dr Dylan PhillipsDr Dylan Phillips Contract LeadContract Lead

TrainingTraining Diploma in Urology (Middlesex University)Diploma in Urology (Middlesex University) Clinic based Clinic based WorkshopsWorkshops Ongoing assessments and examinationsOngoing assessments and examinations

Clinical Team- ConsultantsClinical Team- Consultants

Mr Jim AdsheadMr Jim Adshead Special interest in prostate disorders, UTIs, stone Special interest in prostate disorders, UTIs, stone

disease, renal disease, paediatric (East & North disease, renal disease, paediatric (East & North Hertfordshire NHS Trust)Hertfordshire NHS Trust)

Mr Asher AlamMr Asher Alam Special interest in reconstructive, oncology, female Special interest in reconstructive, oncology, female

urology (Luton & Dunstable Hospital NHS Foundation urology (Luton & Dunstable Hospital NHS Foundation Trust)Trust)

Mr Manoah PancharatnamMr Manoah Pancharatnam Special interest in prostatic disease, andrology, Special interest in prostatic disease, andrology,

paediatric urology (West Herts Hospitals NHS Trust)paediatric urology (West Herts Hospitals NHS Trust)

Clinical Referrals/ PathwaysClinical Referrals/ Pathways LUTS (BPH) LUTS (BPH)

Prior to clinicPrior to clinic• PSA (GP)PSA (GP)• U&Es (GP)U&Es (GP)• MSU (GP)MSU (GP)• IPSSIPSS• Bladder chartBladder chart• Flow rate with bladder scan (Nurse led, at The Elms Medical Flow rate with bladder scan (Nurse led, at The Elms Medical

Practice)Practice) During/after clinicDuring/after clinic

• Urological assessmentUrological assessment• Treatment optionsTreatment options• Follow up in CATS or may need further investigation in Follow up in CATS or may need further investigation in

secondary caresecondary care

Direct referral options into secondary careDirect referral options into secondary care

Clinical Referrals/ PathwaysClinical Referrals/ Pathways StonesStones

Prior to clinicPrior to clinic• Blood tests (calcium, urate etc)Blood tests (calcium, urate etc)• Renal ultrasound scan if clinically indicated from triageRenal ultrasound scan if clinically indicated from triage

During or after clinicDuring or after clinic• Urological assessmentUrological assessment• Low dose CT KUB or CT urogramLow dose CT KUB or CT urogram

Direct referral to secondary care for lithotripsyDirect referral to secondary care for lithotripsy

Clinical Referrals/ PathwaysClinical Referrals/ Pathways

ScrotologyScrotology Prior to clinicPrior to clinic

• Small parts ultrasound scan if clinically indicated from triageSmall parts ultrasound scan if clinically indicated from triage During clinicDuring clinic

• Ultrasound scan (from mid October 2008)Ultrasound scan (from mid October 2008)• AspirationAspiration

Clinical Referrals/ PathwayClinical Referrals/ Pathway

OtherOther Minor ops under LAMinor ops under LA Discussion about current surgical optionsDiscussion about current surgical options

Secondary Care ReferralsSecondary Care Referrals Via Patient Choice Team (STARDOC)Via Patient Choice Team (STARDOC) Direct booking access onto theatre lists - e.g. day Direct booking access onto theatre lists - e.g. day

case cystoscopy, TRUS biopsycase cystoscopy, TRUS biopsy

Benefits of this ServiceBenefits of this Service

For PatientsFor Patients Improved waiting timesImproved waiting times USS prior or at same appt by consultant/GPSI if USS prior or at same appt by consultant/GPSI if

neededneeded Improved care pathwaysImproved care pathways Patient choice re secondary care providerPatient choice re secondary care provider Continuity of care Continuity of care

For CommisionersFor Commisioners Vertical integration with secondary careVertical integration with secondary care Post op f/u retained in CATS Post op f/u retained in CATS

Patient Satisfaction SurveyPatient Satisfaction Survey

100% 100% very satisfiedvery satisfied with the service with the service

FutureFuture

Increase pathways and further Increase pathways and further connections connections

Provide more services within clinicsProvide more services within clinics CystoscopyCystoscopy