Extended role of specialist urology nurses will support outpatient treatment for patients
National review of urology services highlights workforce and service configuration
The latest report from the Getting It Right First Time (GIRFT) programme has called for the further development of specialist urological nursing to deliver high quality, patient-focused urological care.
The GIRFT national report on urology services in England highlights the need for a better career structure for specialist urological nurses, to extend their role and help deliver more treatment in an outpatient setting.
It also recommends greater consultant focus on emergency care, helping to provide definitive diagnosis and treatment for patients who are admitted as an emergency with conditions such as urinary retention and urinary tract stones, which result in an estimated 6,000 patients a year being admitted to hospital.
The report’s author consultant urologist Simon Harrison presents 18 recommendations to improve the care pathway for people requiring urology procedures. The key measures include:
- the national roll-out of dedicated urological investigation units (UIUs), to support greater emphasis on outpatient services and increase day surgery procedures;
- extending the role of specialist nurses to lead on this outpatient work;
- freeing up on-call consultants to provide consultant-led emergency urology care in every trust;
- establishing urology area networks (UANs), comprising clusters of adjacent urology departments, to provide comprehensive coverage of urological services, in order to optimise quality and efficiency.
The report sets out a series of ways to improve the delivery of NHS urology services and offer a better patient experience. It is expected that increased use of dedicated urological investigations units, outpatients’ services and day surgery will provide swifter diagnosis and treatment, without needing to admit patients. In turn, this will reduce unnecessary admissions, length of hospital stays and help improve waiting times for those requiring admission for surgery. Outpatient care is a major part of the urology workload, and a high proportion of urologists’ work is carried out in an outpatient setting. Much of this work can be undertaken by specialist nurses.
The report adds that if more on-call consultants can oversee emergency care, free from elective responsibilities, then it is expected that a greater proportion of patients will have key decisions made about their care on emergency admission and receive definitive treatments rather than interim procedures.
Some reorganisation of the way urology services are provided offers opportunities to make the best use of the specialty’s resources and improve the quality of patient care. There are already established networks for urology cancer care, with certain providers acting as regional centres for particular types of cancer. These existing networks could form the basis for a more comprehensive model.
Simon Harrison said: “Specialist nurses are key members of the urology workforce. It is time that training programmes for specialist nurses and other members of the workforce were developed within a proper educational framework. There is also a need for urology networks – it is clear that comprehensive high-quality urology services cannot be provided across a geographical region without a more structured approach to inter-departmental cooperation.”
Mr Harrison’s recommendations were developed after reviewing data and visiting more than 130 hospital trusts where he met with the clinicians and managers who are responsible for delivering hospital-based urological procedures and care.
The recommendations bring opportunities for efficiencies and savings of up to £32.5m including:
- Increased use of day surgery. This could save up to 12,150 hospital spells a year, equivalent to a gross notional saving of £17.6m.
- Reducing unnecessary follow-up appointments by 150,000 per year could bring a gross notional saving of £13.3m.
- Reducing the number of cystectomy patients who have a length of stay greater than 12 days could save up to 2,580 bed days equivalent to a gross notional saving of £890,000.
- Reducing readmission rates for bladder outflow obstruction procedures could save 385 hospital spells and up to £720,000.
The recommendations are endorsed by the British Association of Urological Surgeons (BAUS) and the British Association of Urological Nurses (BAUN). They will be implemented in partnership with NHS Improvement and alongside bodies such as NHS England, NHS RightCare, as well as directly with hospital trusts, Clinical Commissioning Groups and Sustainability and Transformation Partnerships.
Responding to the report’s recommendations, Mr Ian Eardley, Senior Vice President of the Royal College of Surgeons and practising urologist, said:
“The Royal College of Surgeons is supportive of the recommendations put forward by GIFRT for urology services in England. The changes to the way services are provided which GIRFT advises offer an opportunity to improve the quality of care patients receive.
We are particularly supportive of the recommendations the report makes on variation in emergency practice with respect to stone disease and urinary retention.
The RCS welcomes the proposal to enhance training for specialist urological nurses, and believes that patients would benefit from this being extended to other members of the wider surgical team, including physician associates and surgical care practitioners.”
