1. Go with the flow: the changing pathways in Urology CATS Urology Clinical Assessment & Treatment Service 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 GP at The Elms Medical Practice Clinical Lead Clinical Lead Responsible for running the service and reporting to the PCT Responsible for running the service and reporting to the PCT  Dr Dylan Phillips Contract Lead Contract Lead  Training Diploma in Urology (Middlesex University) Diploma in Urology (Middlesex University) Clinic based Clinic based Workshops Workshops Ongoing assessments and examinations 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) 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) 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) Special interest in prostatic disease, andrology, paediatric urology (West Herts Hospitals NHS Trust)

8. Clinical Referrals/ Pathways  LUTS (BPH) Prior to clinic Prior 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 Practice)Flow rate with bladder scan (Nurse led, at The Elms Medical Practice) During/after clinic During/after clinic Urological assessmentUrological assessment Treatment optionsTreatment options Follow up in CATS or may need further investigation in secondary careFollow up in CATS or may need further investigation in secondary care Direct referral options into secondary care Direct referral options into secondary care

9. Clinical Referrals/ Pathways  Stones Prior to clinic Prior 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 clinic During 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 lithotripsy Direct referral to secondary care for lithotripsy

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

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

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