Governing Body Vice Chair and Lay Member, Enfield

CCG Governing Body Chair, Enfield CCG

Governing Body Lay Member, Islington CCG

Governing Body Chair, Haringey CCG

Secondary Care Clinician, Camden CCG Governing Body

Lay Member, Barnet CCG

Nurse Representative Enfield CCG

Governing Body Lay Member, Camden CCG

Governing Body Chair, Barnet CCG

NCL Chief Finance Officer, Barnet, Camden, Enfield,

Haringey and Islington CCGs

Governing Body Non-Clinical Vice Chair and Lay Member,

Haringey CCG

NCL Accountable Officer, Barnet, Camden, Enfield,

Haringey and Islington CCGs

Governing Body Chair, Islington CCG

Nurse Representative Haringey CCG

Councillor, Haringey London Borough Council

Councillor, Islington London Borough Council

Councillor, Enfield London Borough Council

Director of Public Health, Public Health Haringey

Councillor, Camden London Borough Council

Councillor, Barnet London Borough Council

Healthwatch Haringey

Healthwatch Enfield

Director of Corporate Services, Camden CCG

NCL Director of Performance and Acute Commissioning,

Barnet, Camden, Enfield, Haringey and Islington CCGs

NCL Head of Governance and Risk, Barnet, Camden,

Enfield, Haringey and Islington CCGs

NCL Joint Commissioning Committee

1 March 2018 3-4pm

Cypriot Community Centre,

Earlham Grove, Wood Green,

London, N22 5HJ

Barnet, Camden, Enfield, Haringeyand Islington Clinical Commissioning Groups

Voting Members

Ms Karen Trew (Chair)

Dr Mo Abedi

Ms Sorrel Brookes

Dr Peter Christian

Matthew Clark

Ms Bernadette Conroy

Angela Dempsey

Ms Kathy Elliott

Dr Debbie Frost

Mr Simon Goodwin

Ms Catherine Herman

Ms Helen Pettersen

Dr Jo Sauvage

Sharon Seber

Non-Voting Members

Mr Jason Arthur

Ms Janet Burgess

Ms Alev Cazimoglu

Dr Jeanelle De Gruchy

Ms Pat Callaghan

Mr Hugh Rayner

Ms Sharon Grant

Ms Parin Bahl

Attendees

Mr Ian Porter

Mr Paul Sinden

Mr Andrew Spicer

Apologies

Minutes

TBC

AGENDA

Lead Action Paper Time Page

1. Introduction

1.1 Apologies for Absence Chair Note Verbal 15.00

1.2 Declaration of Interests Chair Note 1.2 15.02

1.3 Gifts and Hospitality Register Chair Note Verbal 15.05

1.4 Opening Remarks Chair Note Verbal 15.08

1.5 Questions from Public Chair Note Verbal 15.10

2. Commissioning

2.1 Adult Medical Urology Services at

Whittington Health

Chair Approve 2.1 15.20

3. Questions from Public

3.1 Question and Answer Session Chair Discuss Verbal 15.50

4. Any Other Business

4.1 Any other business Chair Discuss 6.1 15.58

4.2 Deadline for submission of reports for

the next meeting- Friday 30 March 2018

Chair Note Verbal 16.00

5. Date of next and future meetings:

2018:

Thursday 5 April 2018 3-5pm

Barnet tbc

1

NCL Joint Commissioning Committee

Thursday 1 March 2018

Barnet, Camden, Enfield, Haringey and Islington

Clinical Commissioning Groups

Report title Whittington Health Lower Urinary Tract

Service (LUTS)

Agenda item 2.1

Date

1 March

2018

Lead director Paul Sinden

Director of Performance and

Acute commissioning NCL

Tel/Email p.sinden@nhs.net 020

3688 2906

Report author Paul Sinden

Director of Performance and

Acute commissioning NCL

Tel/Email p.sinden@nhs.net 020

3688 2906

Sponsor(s) (where

applicable)

Tel/Email

Report summary

The Lower Urinary Tract Service (LUTS) clinic is provided by Whittington health and also undertakes clinical research overseen by University College London (UCL). The Lower Urinary Tract Service (LUTS) clinic provides treatments to patients with urinary tract infections which includes prescribing antibiotics in dosages and for durations outside of drug licencing and recognised national guidelines. The clinic provides services to adults.

An independent review of the LUTS service was commissioned from the Royal College of Physicians (RCP) by Whittington Health following concerns over the service after a serious incident. Aligned to this there was concern within the Trust and from many GPs locally about the prescribing regime in the clinic as some of it sits outside of clinical guidelines and /or research governance.

The LUTS patient group has been actively involved in addressing the

action plan in response to the RCP recommendations. The patient group

have been consistent in their view that the clinic should open for new adult

referrals and that there is provision for children. The patient group are clear

that the clinic, and treatment within it, reduces their risk of urinary tract

infection and that standard treatment in secondary care has not helped

them.

2

Whittington Health received the report on the Lower Urinary Tract Service (LUTS) clinic on 19 October 2016, following the invited service review carried out in May 2016. The report made a number of recommendations (27) in order to secure a viable and sustainable safe service for people with lower urinary tract infections.

The RCP made a series of recommendations to ensure the service operated safely and effectively, and recommended that the service not take any new referrals until the recommendations made in the report were met locally. The key requirements for the service to open to new referrals were: • The service be provided from a tertiary setting and/or be supported by

multi-disciplinary team meetings;

• Provision for adults should be separate from that for children;

• A clear succession plan was in place to replace the lead consultant

(Professor Malone Lee) on his retirement;

• The Trust and CCGs assured that the safety and governance concerns raised by the RCP have been satisfactorily addressed.

The report therefore sets out progress against the pivotal

recommendations from the RCP report required for the clinic to re-open for new referrals:

• Establishing a functioning multi-disciplinary team (MDT) to support the clinic and to ensure patient care is informed by expert opinion from a wide range of experts in line with the complex conditions being treated;

• Development of a service specification, and supporting business case, to put the service on a firm commissioning footing;

• Development of a succession plan on the retirement of the lead consultant;

• Further development of the research governance framework for the LUTS clinic;

• Assurance on safety and governance for the clinic.

Following analysis of progress made against the RCP recommendations the paper recommends the re-opening of the LUTS clinic to new patients to Whittington Health Board who will consider the re-opening of the clinic to new referrals on 28 March 2018.

Purpose (tick one

only)

Information Approval

√

To note

Decision

Recommendation The Joint Commissioning Committee is asked to:

• Note the report;

• Recommend the re-opening of the LUTS clinic to new patients to Whittington Health Board on the basis of local achievement of the recommendations in the report from the Royal College of Physicians;

• Note the service specification the LUTS clinic will work to on reopening;

• Note the operational actions that need to be taken to re-open the clinic to new referrals;

• Note the timeline;

• Receive a further update at the April 2018 Committee.

rev

3

Conflicts of Interest Conflicts of interest are managed robustly and in accordance with the NCL

Conflicts of Interest Policy.

Strategic Direction The re-opening of the Whittington Health Lower Urinary Tract Service (LUTS) clinic supports:

• Commissioning the delivery of NHS constitutional rights and pledges;

• Improving the quality and safety of commissioned services;

• Improving health outcomes, addressing inequalities, and achieving parity of esteem;

• Integrating and enabling local services to deliver the right care in the right setting at the right time.

Identified risks and

risk management

actions

The main risks identified with the re-opening of the Whittington Health Lower Urinary Tract Service (LUTS) clinic are:

Addressing the waiting list backlog following closure of the clinic;

Addressing the operational risks identified in the paper.

Resource

implications

Resource implications are identified as follows:

• The business plan for the LUTS clinic will be incorporated in to the 2018/19 contract baseline with Whittington Health, and is reflected in current proposals;

• Costs to commissioners will increase in 2018/19 for:

The costs of prescribing £0.3m (£0.1m for NCL CCGs)

Additional consultant sessions to cover the joint appointment between Whittington health and UCLH £0.2m (£0.1m for NCL CCGs). This will be incorporated into tariff payments in 2019/20.

Engagement

Work to re-open the Whittington Health Lower Urinary Tract Service (LUTS) clinic has been undertaken with the LUTS patient group.

Equality impact

analysis

This report was written in accordance with the provisions of the Equality Act

2010.

Report history Progress on the work to re-open the Whittington Health Lower Urinary Tract Service (LUTS) clinic has been considered by:

• Whittington Health Trust Board;

• Haringey CCG Quality Committee and Islington CCG Quality and Performance Committee;

• North Central London Joint Health Overview Scrutiny Committee.

Next steps Next steps should the Joint Commissioning Committee agree that the conditions for re-opening the clinic set by the Royal College of Physicians have been met are:

• Approval to re-open the clinic by Whittington Health Trust Board on 28 March 2018;

• Service specification for the clinic included in the 2018/19 contract with Whittington Health;

• Clinic opens to new referrals in April 2018;

• Recruitment to joint consultant post between Whittington health and UCLH in September 2018.

Appendices • Update report on the Whittington Health Lower Urinary Tract Service (LUTS) clinic;

• Draft service specification for the clinic.

4

Internal Control Only: This paper together with any proposals have been approved by:

Lead Director

YES

Name Paul Sinden

Date

Whittington Health Lower Urinary Tract Service (LUTS)

1. Introduction

Whittington Health (WH) Lower Urinary Tract Service (LUTS) clinic is currently provided from

Hornsey Central Health Centre. There are approximately 500 NHS patients being treated in the

clinic from CCGs across England. The service has a wider commissioner base than other service

provided by the Trust, with patients from Islington and Haringey making up circa a third of the

patient list.

The clinic is provided by Whittington Health and also undertakes clinical research overseen by

University College London (UCL). The Lower Urinary Tract Service (LUTS) clinic provides

treatments to patients with urinary tract infections which includes prescribing antibiotics in dosages

and for durations outside of drug licencing and recognised national guidelines.

The service is currently led by Professor James Malone-Lee, who retired from University College

London (UCL) in September 2016, and since that time has been employed on a locum contract by

the Trust to continue working part time to help deliver the LUTS clinic.

The clinic is not currently open for referrals for new patients. The Royal College of Physicians

(RCP) Invited Service Review Panel recommended that “until the future of the service has been

determined by the Trust and commissioners, no new patient referrals should be accepted into the

LUTS clinic”. However, the clinic has remained open to current NHS patients.

Since receiving the final report from the RCP Paul Sinden Director of Performance and Acute

Commissioning North Central London CCGs and Jennie Williams Director of Nursing and Quality

Haringey and Islington CCGs have worked closely with the Trust to ensure robust patient safety and

governance processes are in place.

The Trust has been consistent with the patient group that the LUTs clinic will not open until the

Trust Board is satisfied that the RCP recommendations have been delivered. Commissioners

advised the LUTs patient group that the service cannot be commissioned until the Trust has

demonstrated that it can deliver the service in accordance with an agreed service specification. The

key challenge faced by the Trust has been securing a successor for Professor James Malone-Lee.

2. Royal College of Physicians invited service review

An independent review of the LUTS service was commissioned from The Royal College of

Physicians (RCP) by Whittington Health following concerns over the service after a serious incident.

Aligned to this there is concern within the Trust and from many GPs locally about the prescribing

regime in the clinic as some of it sits outside of clinical guidelines and /or research governance. Whittington Health received the report on the Lower Urinary Tract Service (LUTS) clinic on 19

October 2016, following the invited service review carried out in May 2016. The report made a

number of recommendations (27) in order to secure a viable and sustainable safe service for people

with lower urinary tract infections.

5

The RCP made a series of recommendations to ensure the service operated safely and effectively,

and recommended that the service not take any new referrals until the recommendations made in

the report were met locally. The key requirements for the service to open to new referrals were: • The service be provided from a tertiary setting and/or be supported by multi-disciplinary team

meetings;

• Provision for adults should be separate from that for children;

• A clear succession plan was in place to replace the lead consultant (Professor Malone Lee) on

his retirement;

• The Trust and CCGs assured that the safety and governance concerns raised by the RCP have

been satisfactorily addressed.

CCGs have consistently indicated that their approach to the re-opening of the clinic to new referrals

will be determined by progress against the Royal College of Physicians (RCP) recommendations.

Work that commissioners have undertaken to support future service provision includes: • Participation in, and supporting, the multi-disciplinary team (MDT) process with GP and

medicines management participation;

• Agree the action plan to deliver, and review progress against, the recommendations from the

Royal College of Physicians with Whittington Health to determine if conditions for the clinic

opening to new referrals has been reached;

• Developing a draft service specification, for when the clinic re-opens, with Whittington Health.

The draft has been sent to local CCG Chairs and Medicines Management leads for review;

• The CCG will work with Whittington Health and GOSH on the shape of the tertiary service for

children.

The LUTS patient group has been actively involved in addressing the action plan in response to the

RCP recommendations. The patient group have been consistent in their view that the clinic should

open for new adult referrals and that there is provision for children. The patient group are clear that

the clinic, and treatment within it, reduces their risk of urinary tract infection and that standard

treatment in secondary care has not helped them.

3. Local response to report from the Royal College of Physicians

On receipt of the report from the Royal College of Physicians (RCP) in October 2016 an action plan

was developed to address the recommendations in the report. The LUTS clinic remained open for

existing patients, but the RCP required the following to be in place for the LUTS clinic to re-open to

new referrals:

• A succession plan for the lead consultant having been agreed;

• The Trust and CCGs assured that the safety and governance concerns raised by the RCP have

been satisfactorily addressed.

The sections below summarise progress against the pivotal recommendations from the RCP report

required for the clinic to re-open for new referrals:

• Establishing a functioning multi-disciplinary team (MDT) to support the clinic and to ensure

patient care is informed by expert opinion from a wide range of experts in line with the complex

conditions being treated;

• Development of a service specification, and supporting business case, to put the service on a

firm commissioning footing;

• Development of a succession plan on the retirement of the lead consultant; Further

development of the research governance framework for the LUTS clinic;

• Assurance on safety and governance for the clinic.

At a high-level delivery of the action plan has been supported by:

• Desk-top reviews of the action plan to measure progress against the Royal College of Physicians

(RCP) recommendations, with commissioners;

6

• The clinic has remained open to current patients, and the Trust has worked with the lead

consultant to create the conditions for re-opening the clinic;

• There have been regular meetings with members of the LUTS patient group to engage them in

planning and progress;

• The Trust meeting, and working with, commissioners, UCLH, and University College London

(UCL) to progress the action plan.

4. Multi-disciplinary team (MDT) meetings

One important governance and safety measure recommended by the Royal College of Physicians

RCP Invited Service Review was that a multi-disciplinary team (MDT) should be created to meet

regularly and agree on the treatments of patients of the LUTS clinic. Specifically, the RCP said “the

management of these patients, including the medication prescribed, its doses and durations, should

be reviewed, discussed and agreed at properly constituted and well managed MDT meetings with

additional resources committed to it as required.”

A Whittington Health multi-disciplinary team (MDT) has been established – the Pelvic Floor MDT.

The MDT commenced in July 2017 and runs once per month. Clinical representatives from the

CCG (GP and Medicines Management) have attended the MDT and provided positive feedback

around the governance that is in place. Commissioners have indicated to the Trust that the MDT is

operating robustly in accordance with the recommendations of the RCP review.

5. Service specification and business case

A draft service specification has been agreed by commissioners with Whittington Health. As the

specification has been agreed, Whittington Health and UCLH (or another tertiary centre) are now

writing a business case that outlines the Trusts approach and costs to delivering the service,

demonstrating compliance with the commissioner approved service specification.

The completed business case will be presented for approval to the Whittington Health Trust Board

on 28 March 2018. If the business case is approved by the Trust and commissioners are satisfied

that the business case and associated protocols meet the service specification, it will be included in

the Trust’s 2018/19 contract from April 2018.

The service specification is appended to this report. The Committee is asked to note the following

from the specification:

• The service will be a joint service with a recognised tertiary provider to ensure that patients have

access to tertiary level services;

• The service provided is for adults (aged 18 plus). CCGs and Whittington Health have committed

to work with Great Ormond Street to further develop the paediatric tertiary service;

• As a tertiary service referrals will be consultant-to-consultant (from secondary care) rather than

directly from primary care;

• The clinic will be supported by a multi-disciplinary team (MDT) meeting to ensure patient care is

informed by expert opinion from a wide range of experts in line with the complex conditions being

treated. The MDT will include consultant urologists, consultant uro-gynaecologists, consultant

microbiologists and other clinicians relevant to the cases being considered. Primary Care

clinicians have been involved in MDTs held by Whittington Health;

• Every new patient will have their treatment discussed and agreed at the MDT;

• Any treatment outside of nationally agreed guidelines and local multi-disciplinary team (MDT)

agreed guidelines will be provided within the context of an ethically approved clinical trial;

• Diagnostic tests will be undertaken in a manner that is consistent with UKAS accreditation;

Capacity in the future to run the service on a shared-care basis with primary and secondary care.

This would be done according to protocols agreed with clinicians before being put in place;

7

• The service will continue to be provided from Hornsey Health Centre (a Whittington Health

building in Crouch End N8), supported by the Trust putting in place additional clinical and

corporate governance processes. The service will move to a tertiary setting once the research

governance framework has been established;

• Provision for a review of the service specification within 12 months of the clinic re-opening to new

referrals to allow for experience from running the clinic to be reflected in the specification;

• Once the above was in place there would be scope for the service to be provided from a number

of regional centres rather than a single national centre.

The service specification addresses the key recommendations of the Royal College of Physicians

(RCP) review in the following ways: • The LUTS service should continue to care for current adult patients;

• The management of patients should be reviewed, discussed and agreed at a multidisciplinary

meeting;

• Information provided to patients should be accurate and provide information on the risks of the

treatments;

• The clinic should undertake audit of patient outcomes and consent to unlicensed treatments;

• The future of the service would be safe and better regulated as a tertiary centre such as with

UCLH as can therefore offer true multidisciplinary working.

The service specification was shared with the LUTS patient group on 19 February following

agreement of the specification between CCGs and the Trust. Representatives from CCGs and the

Trust met with the LUTS patient group to go through the service specification on 19 February. The

patient group raised a series of operational issues accruing from the service specification that will

need to be addressed:

• The backlog of patients waiting to be referred into and seen by the clinic linked to the requirement

for new patients care to be agreed through the multi-disciplinary team meeting. Referral pathways

and processes will need to be agreed for:

The 200 patients on the existing waiting list for the service;

Patients using the private clinic run by Professor Malone-Lee who wish to be seen on the NHS;

Any patients discharged from the service.

• Alignment of diagnostic testing carried out by the Clinic with UKAS and/or research coverage.

This relates to the use of dipstick tests to identify infection. The patient group have raised

concerns about the alternative form of testing through cystoscopies on their condition.

6. Succession Plan and Research Programme

It is intended that once the commissioners have approved the business case, and the service is

included in the 2018/19 contract, the Trust will work with UCLH or another tertiary centre to

establish a joint multi-disciplinary team (MDT). The joint MDT will commence on the appointment to

a joint Whittington Health and UCLH (tertiary centre) consultant post.

Whittington Health and UCLH have agreed to recruit to a shared consultant post in Urogynaecology

to provide leadership to the LUTS clinic once Professor James Malone Lee is no longer working

there.

If there is agreement between Whittington Health and UCLH (or other tertiary centre) the Trust will

seek approval for the Consultant Job Description by the Royal College of Obstetrics and

Gynaecology, and recruit to the joint consultant post over the summer of 2018.

It is also intended, in line with the Royal College of Physicians (RCP) Invited Service Review

recommendations that a research programme is run in parallel with the clinical service. Where

appropriate, this research programme should include the opportunity to undertake ethically

approved prospective clinical trials of patient treatments. UCLH, Whittington Health, with support

from University College London (UCL) are working together to agree the research governance for

8

the LUTS clinic. UCL can support the development of clinical research proposals and also

applications for funding if required. UCL provides the governance for existing research work carried

out by the lead consultant linked to the LUTS clinic. With regards to the future LUTS service

proposals to establish research trials are being developed targeting a start date of June 2018

subject to securing funding, ethical agreement and sponsorship for the trials.

In line with the recommendation from the Royal College of Physicians work continues towards the

service being based in a tertiary setting. The service specification indicates that when the clinic

reopens to new referrals those referrals will only be accepted via secondary care providers

supported by the Whittington Health multi-disciplinary team meetings have been established since

July 2017. Appropriate onward referrals can then be made into the LUTS clinic which will continue

to be provided from the Hornsey Central Health Centre, pending acceptance of a clinical research

framework that will enable the clinic to be within a tertiary governance setting if required.

7. Safety and governance

The report from the Royal College of Physicians (RCP) made recommendations regarding

strengthening the safety and governance for the clinic. Whittington Health, working with the LUTS

patient group, commissioners and UCLH, has made the following progress:

• Monitoring of compliance with practice restrictions in place;

• Improved consent forms and patient consent forms;

• IT systems integrated to improve links between the clinic and Whittington Hospital;

• Standard operating procedure in place;

• Protocol for use of SKYPE in consultations in place;

• Audit programme for the clinic integrated into the overall Trust audit programme;

• Paediatric pathway in place with Great Ormond Hospital (GOSH). Although the LUTS patient

group remain concerned over the tertiary service offer from GOSH (see section 10 below);

• Completion of the review of the prescribing of nitrofurantoin to address the risk of pulmonary

fibrosis highlighted in the RCP report.

8. Re-opening the Lower Urinary Tract Service (LUTS) Clinic

The Joint Commissioning Committee is being asked to consider whether the conditions for

reopening the Whittington Health (WH) Lower Urinary Tract Service (LUTS) clinic set by the Royal

College of Physicians (RCP) have been met. If the Committee agrees that the RCP

recommendations for re-opening the clinic have been met Whittington Health can commence a

phased re-opening of the LUTS clinic to new patients.

The paper indicates that the conditions set by the RCP have been met:

• A functioning Whittington Health multi-disciplinary team (MDT) is in place;

• A service specification for the clinic has been agreed with Whittington Health for inclusion in the

2018/19 contract with the Trust;

• The Trust is developing a business case for the service in line with the service specification.

Costs for the service have been included in contract baseline negotiations for 2018/19;

• A succession plan for the lead consultant is underway, with recruitment targeted for September

2018;

• Progress on strengthening the safety and governance of the clinic has been made.

The plan is that the LUTs service will have a phased reopening in April 2018, to new patients

referred by secondary care providers, the Trust has been informed by Professor James Malone-Lee

that there is a list of approximately 200 patients on a ‘waiting list’ who will requiring triage by the

multi-disciplinary team (MDT).

It will not be possible to fully re-open in the first instance, as the specification will require joint

multidisciplinary team meetings (MDTs) between Whittington Health and UCLH that support the

SCHEDULE 2 – THE SERVICES

A. Service Specifications This is a non-mandatory model template for local population. Commissioners may retain the structure below, or may determine their own in accordance with the NHS Standard Contract Technical Guidance.

Service Specification No.

Service Lower Urinary Tract Symptoms Clinic

Commissioner Lead NHS Islington CCG

Provider Lead Whittington Health NHS Trust

Period To be confirmed

Date of Review 12 months from start date

1. Population Needs

1.1 National/local context and evidence base The current LUTS service is a community based service run at Hornsey Central Health Centre. There are currently approximately 500 patients being treated in the clinic, from both Islington and Haringey and from tertiary referrals from outside these boroughs. The clinic is currently not open to new patients whilst the succession plan is agreed. This specification will support the implementation of the succession plan. The patients within the service are often complex and have been treated in secondary care prior to referral. For these reasons some patients may not have responded to current national recognised guidance. For these reasons included in the specification planning is a need to include an academic research component to the service to develop evidence for treatment new treatments. The future service will need to be a joint service with a recognised tertiary provider to ensure that the patients have has access to the tertiary level services that are offered by UCLH e.g. urology, pelvic pain, infectious diseases, urogynaecology and uro-neurology. In addition patients with bladder pain and chronic bladder infections are already seen in clinics run by UCLH in urogynaecology and urology. A joint service would operate alongside these clinics and ensure that the treatment and research that is on-going at UCLH is mirrored in the service offered at Whittington Health.

2. Outcomes

2.1 NHS Outcomes Framework Domains & Indicators

Domain 1 Preventing people from dying prematurely X

Domain 2 Enhancing quality of life for people with long-term

conditions

X

Domain 3 Helping people to recover from episodes of ill-health or

following injury

X

Domain 4 Ensuring people have a positive experience of care X

Domain 5 Treating and caring for people in safe environment and

protecting them from avoidable harm

X

2.2 Local defined outcomes

3. Scope

3.1 Aims and objectives of service The objective of the service is to run an adult (>18years) LUTS service that is safe and supported by academic research. 3.2 Service description/care pathway

Referral process The referral process to the service will be consultant to consultant. As a tertiary referral service, the clinical team would accept referrals from across the country directly from secondary care institutions. This will ensure the patients are not lost in the system and can access expertise in timely way. Patient’s currently under the care of the service will not need to be referred but will continue to be cared for.

Multidisciplinary Team (MDT) Working Specialist services such as cancer have long recognised the importance of multidisciplinary team working. This provides the patient with expert opinion and planning of their care from a wide range of experts ensuring good care of complex conditions and a forum for challenge and learning.

This MDT will meet monthly and consist of colleagues from both WH and UCLH (and or another tertiary provider). Included in its membership will be:

Consultant Urologist

Consultant Uro-gynaecologist

Consultant Microbiologists

And any other clinician relevant to the individual’s case.

An MDT coordinator will support the working of the MDT.

1. Every new patient will have their treatment discussed and agreed at the MDT

2. Any treatment outside of nationally agreed guidelines or local MDT agreed guidelines will be

provided within the context of an ethically approved clinical trial

Shared care This patient group is often on long-term therapy. A shared care scheme will be developed and once in place the patient’s GP and secondary care provider will provide shared care.

3.3 Population covered

Haringey and Islington and nationally. 3.4 Any acceptance and exclusion criteria and thresholds Patients will be referred by a secondary care consultant. Every new patient will have their treatment discussed and agreed at the MDT. Any treatment outside of nationally agreed guidelines and local MDT agreed guidelines will be provided within the context of an ethically approved clinical trial. Once a shared care scheme has been developed and is in place, patients stablised on treatment will return to their secondary care provider and GP on a shared care basis. 3.5 Interdependence with other services/providers Microbiology Service Acute Pharmacy Service Acute Urology Service Acute Uro-gynaecology Service Pain Management Service University College London or other academic centre University College London Hospitals NHS Foundation Trust or other tertiary care provider

4. Applicable Service Standards

4.1 Applicable national standards (e.g. NICE) Urinary Tract Infection Guidance for Adults. Quality Standard 90 June 2015 Urinary incontinence in women: management Clinical guideline [CG171] Published date: September 2013 Last updated: November 2015. Lower urinary tract symptoms in men:management Clinical guideline Published: 23 May 2010 4.2 Applicable standards set out in Guidance and/or issued by a competent body (e.g.

Royal Colleges) As specified by the Royal College of Physicians Review 1. Every new patient will have their treatment discussed and agreed at the MDT 2. Any treatment outside of nationally agreed guidelines or local MDT agreed guidelines will be

provided within the context of an ethically approved clinical trial. 3. All diagnostics tests will be undertaken in a UKAS accredited laboratory unless part of a recognised

research programme. 4. The clinic should undertake regular audit of patient outcomes and of consent to unlicensed

treatments. 5. All patient information should provide both risks and benefits of the treatments.

4.3 Applicable local standards Shared care guidance once agreed.

5. Applicable quality requirements and CQUIN goals

5.1 Applicable Quality Requirements (See Schedule 4A-C)

5.2 Applicable CQUIN goals (See Schedule 4D)

6. Location of Provider Premises

The Provider’s Premises are located at: Hornsey Health Centre 151 Park Road London N8 8JD

7. Individual Service User Placement