Learning from practice

The outreach urology service at Edgware Community Hospital allows urology patients to have investigations, treatment and follow-up in a community hospital setting, rather than attending the main Royal Free Hospital site in Hampstead.

The services at Edgware were established in 2000 and include outpatient urology clinics, day surgery cases under local anaesthetic and some clinical investigations. Patients can then elect to continue their follow-up care at the community hospital.

The service is led by Leye Ajayi and Gillian Smith, consultant urologists from the Royal Free Hospital, but the nursing and administration support is provided by Barnet Primary Care Trust (PCT). The Community Hospital is able to take a broad case mix of urology patients; only those patients who need complex investigations, in-patient surgery or specialist clinics must travel to the main hospital site.

The pathway for patients is the same whether they attend Edgware or the main hospital and because the consultants are based at the acute trust, if more complex care is required, it can be arranged directly and without delay.

Edgware Community Hospital provides care in a more convenient location for patients. The site was redeveloped by the PCT on the site of a former acute hospital and the PCT was enthusiastic to commission outpatient services in the new building in partnership with other trusts.

This represented an opportunity for the Royal Free Hampstead NHS Trust to increase activity where there was a high demand for the service. Urology is just one of the services delivered by the acute trust in Edgware Community Hospital; ENT, ophthalmology and general surgery day case procedures are also provided on site.

Operating services on two sites is a challenge for the Royal Free Hospital and there can be pressure for specialties to consolidate services on to one site. However, the urology service at Edgware is seen as important activity for the Trust and a recent increase in consultant numbers has greatly improved the ability to make the most of the extra capacity at Edgware.

A close relationship with the PCT has been very important in developing and maintaining the service. Good communication between staff on the two sites has also been essential. The opportunity to have minor procedures carried out at Edgware has been popular; most patients who have their initial treatment or consultation at the community hospital choose to continue their follow-up there, which may include some diagnostic tests. Gillian Smith, Consultant Urologist said, “Many patients prefer the community setting because of its convenience and also the setting - the building is modern, pleasant and purpose built.”

Many patients find the prospect of visiting Edgware Community Hospital less imposing than an appointment at the main hospital. Miss Smith said, “I am often able to alleviate any concerns patients have around their investigations or treatment by offering appointments in a community setting where they can be sure of being seen by a particular doctor.” There are future plans to expand the services offered at Edgware Community Hospital.

The Royal Free urology consultants are currently training two of the trust’s nurse specialists to start running nurse-led clinics. In addition, the Trust would like to start offering rapid access cancer diagnosis clinics.