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Advice and Guidance response templates for urology now available in GIRFT outpatient resources

Templates for responding to Advice and Guidance (A&G) requests are now available as part of a collection of resources from GIRFT to support urology teams to transform and improve outpatient services.

The outpatient resources include a toolkit and the templates as well as guidance for improving the use of Patient Initiated Follow Up (PIFU) and remote monitoring (RM). These are now available on the GIRFT FutureNHS workspace.

Andrew Dickinson, GIRFT’s outpatient transformation lead and a consultant urologist at the University Hospitals Plymouth NHS Trust, led the GIRFT working groups developing both resources. Twenty clinicians from both primary and secondary care were involved in shaping the A&G toolkit, to ensure the templates are helpful to both the specialists using them and the GPs receiving them.

“The NHS has seen major changes to outpatient services in recent years, accelerated by adopting remote consultations and telemedicine during the pandemic. It is vital that we now maximise the opportunity to take new approaches for the benefit of patients. A&G, PIFU and remote monitoring are crucial to efficiently performing outpatient services in not only urology, but many other specialties. We hope these guides can support trusts to implement best practice and to empower patients through shared decision-making, whilst minimising unnecessary and inefficient outpatient activity.”

More details on the new resources:

Urology A&G toolkit and templates

A&G, also known as Specialist Advice Services, allows GPs to obtain advice from specialists in secondary care, which means patients get a decision and advice on their suspected condition made more quickly than waiting to see a specialist in the outpatient department.

The GIRFT toolkit offers tips on making optimal use of A&G, and include templates which can be adapted in response to A&G requests for 17 common urological conditions, including lower urinary tract symptoms, chronic testicular pain and stress incontinence.

The colour-coded templates aim to improve the timeliness and quality of responses back to GPs, allowing a personalised response which is specific and targeted to the patient, with the most important information clearly highlighted and scope for local processes and requirements to be flagged.

The urology templates are the first in a series GIRFT is working on, with templates for dermatology, ENT, gynaecology and children and young people (CYP) requests also being developed.

Urology PIFU and Remote Monitoring templates

Patient Initiated Follow Up (PIFU) and remote monitoring (RM) allow patients with longer-term conditions to manage their own health with support from specialists, by enabling them (or their carer) to contact health providers as and when they choose.

The new GIRFT guide offers best practice advice for the effective use of PIFU – including logging and tracking patients on PIFU pathways and putting effective safety nets in place – and advice for patients suitable for remote monitoring.

PIFU pathway templates are currently included for urology patients in 10 cohorts, including those who have had bladder-outlet obstruction surgery or those with recurrent urinary tract infections (UTIs). The templates set out which patients PIFU is appropriate for, what type of PIFU should be used, information that should be provided to the patient, the methods of contact for accessing follow-up and timelines for clinical review or discharge.

Remote monitoring pathways are also provided for cystectomy patients, those with prostate and renal cancer and those with renal cysts in need of follow-up.

The guide will be updated over time to add in new PIFU and RM pathway templates. Urology colleagues are encouraged to share suggestions for potential inclusion by emailing girft.academy@nhs.net.

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