Transforming urology pathways to improve care and reduce delays

Evidence from the local Birmingham and Solihull Integrated Care System indicated very long waits for urology care resulting from challenges post-COVID-19. Secondary care teams were working very hard to address these delays. However, the existing routes to change were constrained by traditional approaches and trying to add more capacity to the existing pathway. The teams still struggled to catch up with the backlog demand.

As primary care providers, the project team were able to try new ways of working without the historical challenges faced by secondary care. The support of Q Lab helped give this small organisation the legitimacy needed to trial radical approaches.

The team piloted a new urology pathway focused on supporting patients much earlier in an enhanced primary care setting. The initiative brought to life the desired one-stop approach to managing and supporting urology patients in the community by leveraging virtual apppointments, conducting face-to-face out-of-hospital consultations and providing diagnostics in a local hub setting.

The team faced key challenges in attempting this radical redesign. These included an understandable questioning of why the new methods would work. They also found they lacked internal improvement skills and change capacity. Furthermore, they needed funding for the clinical support required to test and develop these new pathways. Q Lab was pivotal in helping to successfully overcome these challenges.

• This innovative urology approach reduces variation by providing rapid local access to specialist knowledge and support. This ensures more patients are on the right pathway as early as possible in their care journey.
• Focusing support much earlier in the pathway reduces delays and lessens potential acuity by cutting unnecessary hospital admissions.
• Clinical and non-clinical staff report increased confidence and reduced administrative burdens due to this streamlined system.
• The service has helped increase the capacity of staff, who can then support patients by developing new skills in a primary care setting.
• The service maximised integrated working among staff to support patients though collaboration and single IT systems.

Through this new pathway, the pilot cohort demonstrated that almost 90% of patients do not need to go to secondary hospital care for urology care. The team supported these patients earlier in the pathway to reduce the potential need for acute care resulting from delayed support.

By utilising primary care-based clinicians and local hub settings, the team found lower cost alternatives to deliver care.

The team initially provided this model for one practice but have expanded to support over 50 practices. They have shared their work locally with the confidence that it can be scaled and replicated both locally and nationally.

Patients have given excellent feedback on the impact of this new way of working. Of the first 800 patients supported, 96% were satisfied with the service provided. 100% of patients indicated they would recommend the service to friends and family.

A urology service user interviewed about the impact of this new approach passionately shared:

This work successfully demonstrated that even complex specialties can be transformed to be delivered in local community settings. This can free up stretched capacity in secondary care for patients who need hospital care. There is now a catalyst and blueprint to test other areas that can move care out of hospital. Delivering urology and other specialty care in communities across England would make a huge difference to ensuring the NHS not just survives but thrives.

The team shared their work with the Birmingham and Solihull Integrated Care System, where it has been received very positively. This has led to discussions with the commissioners about how the team might expand this type of work in the future.

NHS England have written and published a dedicated case study on the success of this work, with a focus on how the team used innovative approaches to transform the workforce for this new delivery approach.

Based on the success of this work, NHS Confederation asked the team to present at the Care Closer to Home national conference for best practice. The work was received very positively.

The success of the Q lab approach

The Q Lab process encouraged trying new approaches and adapting based on the learnings. This test-and-refine approach helped the team develop many new iterations of their prototype to achieve a much more impactful version than the first early design. The team also found it very helpful to use input and ideas from external and internal stakeholders to really challenge their thinking. This ensured they pushed the boundaries as far as possible.

While the team initially worried this approach may slow them down, spending more time on the design phase helped accelerate future success. For example, the original January 2025 project plan target was to achieve 50 practices accessing the service. However, by October 2025, we had already achieved 51 practices accessing the service from nine primary care networks. Working together to stay resilient despite the hurdles and supporting the team were essential.