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Clinical leads for GIRFT urology

The clinical leads for the GIRFT urology workstream have recently been working on the programme of re-visiting trusts.

Mr Kieran O’Flynn, Consultant Urological Surgeon at Salford Royal NHS Foundation Trust (left), and Mr John McGrath, Consultant Urologist at Royal Devon and Exeter NHS Foundation Trust (right), have replaced Simon Harrison as GIRFT’s joint clinical leads for urology.

Simon continues to be involved in the programme and to offer advice after publishing GIRFT’s first national report on urology in July 2018, together with a handbook (see below) containing both a guide to setting up urology area networks (UANs) and good practice case studies to share with trusts.

Click here to read the most recent GIRFT publication in the March 2022 edition of the Journal of Clinical Urology (JCU): "To what extent have key recommendations from the 'Getting It Right First Time' programme for urology in England been implemented?"

What was the aim of GIRFT urology?

Mr Kieran O’Flynn and Mr John McGrath have lead GIRFT’s re-visits to trusts, presenting refreshed urology data and looking at the progress of recommendations since the 2018 national report.

Professor Tim Briggs, chair of the GIRFT programme and National Director of Clinical Improvement for the NHS, said:

Kieran and John are both hugely respected in the world of urology, and I am delighted to have them on board with GIRFT as we move into the second phase of our work to help improve urological services.

"The recommendations in Simon Harrison’s national report have been instrumental in driving significant changes for the better in units across England, but there is always more we can do. I look forward to seeing further innovation and improvement as our re-visit process gets under way …"

Mr Kieran O’Flynn, Past President of the British Association of Urology Surgeons (BAUS), said:

I’m delighted to be joining the GIRFT team with John McGrath.

"Simon Harrison’s excellent report signposted many of the challenges facing the specialty. With a workforce shortfall in urology and with the rising urological requirements of an ageing population, there is a pressing need to develop the urological workforce, while ensuring that standards are maintained.

"The GIRFT report identified significant national variation in the management of common conditions, and I look forward to helping support the progress of urology area networks, enabling the development of specialist care and improving core services in elective and emergency care …"

Mr John McGrath, Clinical Director of the South-West NHS Genomic Medicine Centre, said:

The GIRFT programme has enormous potential to deliver further improvements in urological care for patients across England by building on the strong platform that Simon Harrison and his team have already established.

"I am looking forward to supporting the ongoing development of UANs as well as accelerating the spread of best practice in areas such as day case surgery.

"Specialist nurses are right at the centre of high quality urological care and we have a great opportunity to working alongside the British Association of Urological Nurses to look at how we develop these roles further …"

Handbook of good practice in urology

Mr Simon Harrison, former GIRFT Lead for Urology, circulated the following information for BAUS members in January 2020: 

Following on from the GIRFT National Specialty Report on Urology, the GIRFT team have published a handbook of good practice in urology, "Gettging It Right In Urology"This contains:

  • Guidance on how Urology Departments and Trusts might go about establishing collaborative working arrangements within a Urology Area Network.  It is hoped that most Urologists will, by now, be aware of which other Urology Units they are likely to be networking with.
  • A set of 23 case studies, produced by Urology Departments from around the country, that describe innovative ways of working and delivering services.  These examples of such practice came to light during the GIRFT visits to Trust Urology Departments.  There are doubtless many other examples which remain largely out of sight to the Urology community. 
"It is hoped that the portfolio of case studies will increase over time; BAUS members are encouraged to contact the GIRFT Urology team with further examples of innovation that would be of wider interest.  It should be noted that GIRFT has not formally evaluated the practices that the case studies describe - clinicians are urged to judge whether adopting similar protocols and procedures would be expected to be of benefit to their own department.  This is information-sharing, rather than a policy-directive ..."

Download the handbook Getting it Right in Urology - first published in December 2019

Other GIRFT publications

The 2018 National Report presented 18 recommendations to improve the care pathway for patients, including rolling out dedicated urological investigation units (UIUs) to support greater emphasis on outpatient services and increased day surgery procedures, extending the role of specialist nurses to lead on outpatient work, and establishing Urology Area Networks (UANs) from clusters of adjacent urology departments providing comprehensive coverage of services.

Following on from the work of Simon Harrison, the "Getting it Right in Urology" case study handbook above was sent to all trusts, offering examples of the good work and innovations seen during the national review as well as information on how to set up a UAN.

Additional information from GIRFT

Latest publications from GIRFT

National consensus pathway for testicular torsion in children and young people - is the most recent publication from GIRFT (March 2024), prepared in co-operation with BAUS, and can be found on the GIRFT Paediatric Surgery & Urology pages.

This pathway document follows on from the publication of the NCEPOD report on testicular torsion.


Urology Area Networks (UANs) & new ways of working

Everyone now realises that there has been no quick return to the pre-COVID-19 ways of working, and that some changes in practice will be permanent. The Getting It Right First Time programme team was asked by NHSE/I to collate examples of new ways of working that have been successful and could be adopted across the country. 

Online data collection for this survey by NHSE/I closed some time ago but, if you do have information about successful Urology Area Networks that you wish to share, you can still email this to Kieran O'Flynn or John McGrath. The information required includes:

  • name of hospital Trust;
  • nature of the innovation and how it changes the patient pathway;
  • impact of the change in terms of population health outcome, safety, efficiency, productivity;
  • what is needed to sustain this change in practice; and
  • have there been any problems with the change?

A summary of these data on UANs is now available by clicking here, or by using the link from the GIRFT website and visiting the GIRFT Urology Surgery Academy Resources page.


GIRFT webinars on this website

Upcoming webinars under the banner of GIRFT and the National Clinical Improvement Programme can be found here on the e-Learning page.

Recordings of past webinars are available here on the Webinar Archive page.

You can find webinars & their recordings under the "Clinical Quality (GIRFT) & Audit" tab of the pages above


Delivery guides & disease-specific pathways

These consultation documents have been published by GIRFT in partnership with BAUS, BAUN & BADS, and are available from the GIRFT website by clicking on their Urology Surgery Academy Resources. You will find them grouped under the following headings:

  • GENERAL GUIDANCE  (e.g. UANs, UiUs, care for kidney & bladder cancer, care for acute stones, care for BOO, outpatient transformation, recovery from COVID lockdown etc);
  • PATHWAYS  (e.g. kidney cancer, male bladder outflow surgery, bladder cancer, acute stones, cystoscopy, minor peno-scrotal surgery & pathway code recipes);
  • CODING FOR CLINICIANS  (e.g. guidance on surgery for BOO & a full list of urology codes); and
  • CODING FOR CODERS  (e.g. guidance for urethroplasty & male bladder outflow surgery).

A link to the Suspected Cauda Equina pathway can be found by clicking here - BAUS has contributed to this document but it is not available in the Urology area of the GIRFT Best Practice Library


Best practice timed diagnostic pathways

Getting It Right First Time (GIRFT) and NHS England’s Cancer Programme have worked in partnership to produce guidance for Best practice timed diagnostic cancer pathways, outlining how cancer alliances and local organisations can implement NHSE’s best practice timed diagnostic pathways for cancer.

The guidance has a particular focus on prostate cancer, skin cancer and colorectal cancer, with other cancer specialties to follow. It includes advice for all stages of a cancer diagnosis, as well as useful insights from GIRFT clinical leads and links to best practice case studies.