Collaborative Pathways

Community Urology and Continence Sustainable Healthcare Partnership

1. What is this work about?
2. A comprehensive service, in the right place
3. Who are the partners in the SHPartnership

Community pathways for GPs:

1. Female urinary continence
2. Male lower urinary tract symptoms – new community pathway
3. Prostate Specific Antigen (PSA) follow-up

What is this work about?

The Urology Department with their health partners have taken up the challenge, in Cambridgeshire, to participate in redesign of health services so that they adopt best practice, are provided in the right setting, performed safely and effectively and with financial sustainablility.

We have developed an integrated urology service ensuring patients are treated in the most appropriate setting for their condition. This may be primary care, a community clinic or a one stop hospital clinic. A network will ensure that all clinicians are supported in managing urology patients and have access to advice when needed.

A comprehensive service, in the right place

Most urology patients in Cambridgeshire are treated and followed up in secondary care. The partners have identified several areas where this work could be done more appropriately in the community with the support of secondary care when appropriate; female urinary incontinence, male lower urinary tract symptoms and PSA follow-up.

Who are the partners in the SHPartnership

The Urology and Gynaecology Departments at Addenbrooke’s and Hinchingbrook Hospitals work with GPs, the NHS Cambridgeshire, Cambridgeshire Community Services NHS Trust and various local commissioning groups including CATCH. The Community Urology Partnership is co-chaired by Dr Mark Brookes, GP Nuffield Road Surgery, and Mr Christof Kastner, Consultant Urologist.

Female urinary continence

Historically, the community-based continence service has been limited and fragmented which has led to GPs referring directly into secondary care. As a result of our collaboration, a new gynecology/urology female continence pathway has been developed in line with current NICE guidance.

Summary: Urological referral after referral to Cambridge Community Service for a trial of conservative management.

Advice: Initial referral should be made to Cambridge Community Services for conservative management of urinary incontinence as described in the Continence Pathway.
For more information on the continence services available in your area and for downloadable referral proforma, please click here.
Once on the website, select your practice location, then select continence advisory service.
Please click for access to male and female bladder health patient information leaflets:
For general advice on continence problems, contact the District Continence Advisors, Mrs Jane Dowse or Mrs Barbara Constable, at the Princess of Wales Hospital, Ely (Tel 01353 652145 Fax 01353 652146)
Refer To: Any adult urologist

TWOCs

Trials without catheters are to be carried out in the community where appropriate. Please see the Male LUTS pathway or contact Cambridgeshire Community Services Continence Team for further information and referral pathways. District nurses are aware of these and should be available for this.

Male lower urinary tract symptoms – new community pathway

The partners have developed a new male Lower Urinary Tract Symptoms (LUTS) community pathway, in line with current NICE guidance.
Advice: GPs are available to advise conservative and drug management to many men with mild and moderate LUTS with the help of the interactive Male Lower Urinary Tract Symptoms pathway. This pathway also indicates referral in men with LUTS who have failed medical treatments, with acute and chronic retentions.
We would like GPs to exclude serious systemic illness and indicators for prostate cancer.
Please provide information with regards treatments tried when referring to the Urology Department. Please refer according to the links below.

Click here for more pathway and other information.

Prostate Specific Antigen (PSA) follow-up

Prostate Specific Antigen (PSA) follow-up (for actual or suspected prostate cancer) takes place mainly in the acute setting. Treatment in a hospital setting is often less welcomed by patients and is less cost effective than provision in a GP practice.

PSA follow-up will be carried out, where appropriate, in a community setting, with an oversight and education service provided by the acute trust. Structured discharge methods will be used to facilitate shared care, with clear re-referral criteria and rapid specialist responses to queries.