The Community Urology Service (CUS) – Information for GP’s

The Community Urology Services (CUS) is delivered by Sussex Medical Chambers in the heart of our local communities, which means outside of the acute hospital settings.

From various locations across Sussex, we provide medical consultations, treatments and minor surgical procedures relating to the following conditions:

• Male lower urinary tract symptoms (LUTS)
• Chronic male pelvic pain (including chronic scrotal and prostatitis)
• Scrotal swelling
• Benign Prostatic Enlargement (BPE)
• Female urinary incontinence
• Erectile dysfunction
• Foreskin Problems
• Recurrent urinary tract infections
• Haematospermia
• Persistent loin pain
• Catheter related problems (recurrent UTI’s, recurrent obstruction, pain)

We do not conduct Flexi cystoscopies within the service but can refer on under the CUS pathway to a provider of flexi cystoscopies if deemed appropriate as part of the treatment investigations under CUS.

The CUS service will also perform minor surgical procedures that can take place under local anaesthetic, including:

• Circumcisions
• Urethral Dilatation
• Frenuloplasty
• Penile scrotal lesions
• Epididymal and penile cyst removal
• Dorsal Slits
• Preputioplasty
• Vasectomy (please refer to the Community Vasectomy Services )

Other procedures that have been identified under the treatment plan which require a day case or general anaesthetic will be referred to a secondary care (hospital) setting of the patients choice.

Our service ensures that the patient moves appropriately and seamlessly between primary, community and specialist secondary care services.

As a community service operating out of hired sites, we do not always have ready access to patient positioning hoists. If your patient has specific mobility requirements and is unable to self-transfer / will not be escorted by a trained carer please indicate on the referral form.

The service is designed to support the care of the patient being in line with national guidance including NICE guidance and that published by the British Association of Urological Surgeons on the management of urological conditions.

The CUS Self Care Approach

Self-care and the development of self-management means are pro-actively promoted by the CUS for patients through education and agreed supported self-management plans. The CUS also supports GP’s and other health professionals in providing appropriate urological patient information, and signposting to other services to enable the patient to manage their condition appropriately prior to referral.

This will include the following:

• Development and or active usage of condition-specific guidance for the management of conditions through self-care, supporting patients and primary care practitioners to follow this guidance
• The use of personalised care plans (that can be shared between GP, patient, and other services as appropriate) that clearly outline how the patient should self-manage e.g. advice on condition flare up
• Signpost patients to information in different media, e.g. websites, leaflets or help lines.
• Together with the patient, review them holistically and how this may affect their urological condition, refer when appropriate to Health and Wellbeing Services for healthy lifestyle support, social support as well as psychological support through referral to Time to Talk Services.

Services out of Scope

The CUS services are not appropriate for patients who are under 17 years old at the time of the appointment or those being referred for suspected cancers/2 week wait rule.

Incidental Cancer Pathways

Incidental cancers: Patients with suspected cancer should be referred under the 2-week rule direct to the relevant service and are not referred to the CUS.

Unexpected cancers: in the event that an unexpected cancer is found when carrying out or reporting a routine procedure and within 2 hours of discovering the condition, the CUS clinician will ensure that:

• the procedure is reported urgently
• the patient is informed urgently
• The patient will be referred onto an appropriate cancer pathway
• An email should be sent immediately to the GP and the referrer (if this was not the GP) outlining the outcome of the report and the referral
• CUS follow the agreed referral pathways with secondary care providers to ensure any onward referrals are made in a timely, effective way without delay and to allow an urgent referral to be made to an acute provider which can be converted once received on to a 62 day pathway.

Formulary and Prescribing Approach

Bus Route: 100 fastway, 281, 291

Horsham

The Village Surgery (Car Park onsite)

Bus Route: 23, 626, 668

Park Surgery (limited parking on site, street parking available)