2. LOWER URINARY TRACT SYMPTOM MANAGEMENT CLINIC Julia Taylor Nurse Consultant Salford Royal Hospital NHS Foundation Trust

3. AIMS OF SERVICE To provide a clinically appropriate tier 2 service in a primary care setting To provide a clinically appropriate tier 2 service in a primary care setting To provide a cost effective care pathway To provide a cost effective care pathway To respond to the local health needs To respond to the local health needs Build on development of Urology i CATS model - timely appointments Build on development of Urology i CATS model - timely appointments Clinic run in primary care / i CATS facility Clinic run in primary care / i CATS facility To ensure auditable pathway To ensure auditable pathway Utilise a structured clinical governance framework Utilise a structured clinical governance framework Deliver : ‘Safe, Clean & Personal’ Salford Royal Foundation Trust Deliver : ‘Safe, Clean & Personal’ Salford Royal Foundation Trust

4. CURRENT SITUATION Management LUTS in primary care NICE 15% referrals to urology department for patients with LUTS * audit 12 weeks iCAT model triage clinic Existing model of nurse led service in secondary care * British Association Urological Nurses BAUN 2003 Existing equipment availability –portable Clinical governance framework includes : - regular audit - assessment of competencies - assessment of competencies - Clinical supervision - Clinical supervision

6. CAPACITY & STAFFING Fortnightly clinic 5 New 4 Follow Up patients Provided by secondary care Urology Specalist Nurse (0.21 wte) Health Care assistant (0.21 wte) Provided by Primary Care Managerial & Administration staff

7. CLINIC PROTOCOL Eligibility Criteria Adult male patients Adult male patients Lower Urinary Tract Symptoms Normal Renal Function Normal Age Specific PSA Urinalysis / MSU NAD Exclusion Criteria Suspected Cancer TWW referrals Suspected Cancer TWW referrals Abnormal /Absent Pre Clinic Investigations Presence of Secondary Urological Problems

8. Triage outcomes

10. Outcomes from new appointments

11. Outcomes from follow up appointments

12. BENEFITS Ease for GP to refer into service Ease for GP to refer into service Streamlined pathway Streamlined pathway Rapid ongoing referral Rapid ongoing referral Treatment regimes - Non Medical Prescriber [NMP] Treatment regimes - Non Medical Prescriber [NMP] Lifestyle advice Lifestyle advice Medical treatment advice to GP Medical treatment advice to GP Referral for further investigation Referral for further investigation Referral for surgical treatment Referral for surgical treatment Follow up as required - NMP review * National Prescribing Centre Competencies Follow up as required - NMP review * National Prescribing Centre Competencies Structured Clinical Governance framework Structured Clinical Governance framework ‘Safe Clean & Personal’ Salford Royal Foundation

14. CONCLUSION Uncomplicated LUTS can be effectively managed in a primary care setting Uncomplicated LUTS can be effectively managed in a primary care setting High patient satisfaction levels High patient satisfaction levels A robust system for patient selection is required A robust system for patient selection is required Ongoing professional development and clinical governance arrangements important to the delivery of a safe patient focused service Ongoing professional development and clinical governance arrangements important to the delivery of a safe patient focused service