The purpose of the initiative was to improve the quality of care for men with lower urinary tract symptoms (LUTS). Clinical peer review was focused on evidence of implementation of NICE guidance on the Management of LUTS in men (NICE, May 2010) at the point of referral from primary care. Detailed feedback to individual clinicians was supported with educational materials with a focus on shared decision-making by educating clinicians and empowering patients. Primary care clinicians receive an increasing quantity of evidence-based advice, guidance, pathway must-dos and don't-dos that all have to be achieved in a working day. It is easy for them to be overwhelmed by information. Crucially the initial decisions, made by the patient and clinician in the consulting room, drive the pathways and costs in the NHS. The 'right decisions at the right time to the right place' gives better outcomes and better use of resources for all. The statement is based on anecdotal evidence that a referral to the wrong speciality results in delay for patients. GPs are then asked to re-refer to the right department. This creates 2 first outpatient appointments and an unspecified but significant time delay. The presumption is that quicker assessment and action leads to better outcomes for patients. Informed patients are also central to the right decisions. The aims were to: Raise public and clinician awareness of SDM, supported by PDAs Educate clinicians on using PDAs and SDM to deliver high-quality care (the one off cost of the clinical meeting is the price of the venue). Materials are available from websites and have no additional cost Drive decision-making with empowered patients by making PDAs widely available in the community Facilitate behaviour change by: - providing personal feedback to individual referrers based on an audit of their referral data - using the NICE LUTS guideline to assess the quality of pre-referral care - disseminating educational material based on the NICE LUTS guideline Reduce the number of inappropriate referrals Demonstrate improved quality of referrals that reflect the implementation of the NICE LUTS guideline. The intention was to test an approach to referral management that focused on the quality of decision-making between clinician and patient. This entailed using peer reviews of referrals to provide feedback to individual clinicians on their referrals. This was supported by education materials developed with consultant colleagues, based on agreed quality markers from the NICE LUTS guideline. The plan was to: Test this approach to a single pathway and apply the learning and processes across other clinical areas Reduce the number of inappropriate referrals Demonstrate improved quality of referrals that reflect the implementation of the NICE LUTS guideline Explore ways to engage patients in the community so they can get the information they need to inform decisions for their health. By achieving these objectives the hope is to show value for money and best use of NHS resources.