What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

Increased demand for Urology services pre and post pandemic has led to long waits for patients in Secondary care in our Integrated Care system. This clearly is through no fault of Secondary Care providers and we as a system partner in Primary Care, want to help as much as possible to reduce the demand going into these services.

Transforming pathways and backlog, during unprecedented delays in care, is a very difficult joint goal to deliver. However, we believe it is essential that we test solutions that deal with the current problem of long waits for Urology services and simultaneously transform current ways of working to ensure long term sustained benefits of a pathway redesign for patients.

We have worked with Senior Urology Consultants to review typical cases that they see after long waits. They have confirmed we can support these more locally and quicker in an enhanced Primary Care service.

What does your project aim to achieve?

10-months Objectives:

Due to long delays and waits for Urology services in our Integrated Care System, we want to help the redesign of Urology pathway to help ’empty the current full bath’ of long waiters and ‘reduce the flow of the tap’ of new referrals, in a single improvement approach.

Intended Benefits:

• Support patients earlier in pathway and more locally in Primary Care to avoid unnecessary visits to hospital and reduce inappropriate demand for secondary care Urology services.
• Support development of more knowledge and expertise in Primary Care Clinicians to reduce referrals.
• Support hospitals by providing a route to transfer patients from waiting lists into our service to reduce their workload.
• The service is delivered via Consultants working in patients Primary Care record with full medical history. This provides an opportunity to increase safety and reduce inequalities from patients not being able to fully articulate history in traditional outpatient settings.

How will the project be delivered?

Stakeholder Engagement:

We have engaged with secondary care clinicians and primary care clinicians to help us have a Clinically led pathway redesign approach based on their experience of current pathway and patients they support.

Early testing of concept:

To test theory and feasibility of this new approach and minimise wasted resources, our lead Urology consultant has worked with our lead Primary Care Clinician to successfully support a small scale test of concept in one practice location.

Scaled up testing phase:

We now need to move this service to a much wider population offering to test it’s scalability. We will continue to collect data from Clinicians and patients to determine ongoing success and good use of limited resources.

Project delivery approach:

We will implement an agile improvement project structure with regular reviews of progress and risk to mitigate barriers to success. Senior management are sponsoring the project to ensure full backing.

How is your project going to share learning?

We have recently appointed a new Communication Lead who will be part of the project team to ensure we can capture project success and learning stories. This will be shared on our website, social media and at local/regional events. This includes Integrated Care System events and Primary Care events.

We are also part of NHS England’s network of best practice sharing for transforming outpatients and will share via that route.

We share changes and results on Urology Clinical networks.

This project maybe focused on Urology but there are many other specialities that have not traditionally been delivered in Primary Care. By successfully working with stakeholders to demonstrate the ‘art of the possible’ in this complex area, we can inspire more transformation work in other specialties, thus, increasing the positive impact of this work. To help achieve this we plan to share the work via wider Clinical networks than just Urology.