Shared learning database

Central London Community Healthcare NHS Trust
Published date:
August 2009

NHS Kensington and Chelsea Practice Based Commissioning Group led the re-development of the Community Continence Service based on the implementation of NICE guidance on conservative therapy.

In January 2015 the service provided an update to NICE. There are no significant changes to the way the service runs. The service is now commissioned by West London CCG as NHS Kensington and Chelsea PCT no longer exists. The service continues to be provided by Central London Community Healthcare NHS Trust for the borough of Kensington and Chelsea. We have updated the contact details on this submission.

*Please note that this example was previously submitted for CG40 but the practice it details remains current against the updated guidance CG171.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

The overall aim was to appropriately assess and treat patients with continence problems in the community by funding additional specialist nursing capacity for the community continence service and a new Women's Health and Continence Physiotherapy Service. It is intended that the proposed local service model will not only increase capacity and capability in primary care to deliver evidence based services, but will also base service delivery on an integrated care pathway across primary and secondary care which reflects NICE guidelines and best practice. 1. Invest in community continence services to improve access and reduce unnecessary referrals
2. Ensure only patients with complex problems are seen in secondary care
3. Provide early intervention to prevent deterioration of the condition

Reasons for implementing your project

Practice Based Commissioning (PBC) led a review of 18 week waiting times in Urogynaecology services. Based on the review findings it was identified that up to 40% of referrals to secondary care Urogynaecology departments were for continence problems and that these could more appropriately be assessed and treated in primary care. In conjunction with the review PBC worked with the Public Health Department to estimate the prevalence of urinary incontinence problems in Kensington and Chelsea. It was identified that the prevalence of continence problems is high with between 12 - 15,000 women and 2 - 3000 men, and that there is a significant amount of unmet need.

How did you implement the project

1. The PCT approved funding for additional specialist nurse capacity and a women's health and continence physiotherapy service. 2. The Specialist Women's Health and Continence Physiotherapy service was externally procured using Supply2 Health to stimulate the market and to allow the PCT to select the provider offering best Value for Money (VfM) and quality (we advertised for a service not individual posts as this offered better value for money). 3. To ensure that the new service was fully integrated the nursing team and the physiotherapists attended a process mapping exercise where the patient pathway was mapped against NICE guidance. 4. The new service will be publicised via the PBC Plenary Forums and Protected Time for Learning events, in order to engage General Practitioners and promote conservative interventions. 5. The newly developed service will also out reach to hard to reach groups locally via the voluntary sector to improve access to the service, reduce unmet need, and reduce the stigma often associated with incontinence.

Key findings

The service will be monitored quarterly against a number of metrics as agreed by the non-acute commissioners and outlined in the Community Service Contract. This data will be captured via the Community Information System (CIS). Metrics the service will be measured against include activity performance indicators. In addition patient outcomes will be systematically measured across the continence service using NICE recommended Kings Questionnaire. This measures both symptom improvement and quality of life.

Key learning points

1. To always consult throughout the process with key stakeholders such as secondary care, non-acute, users, and general practitioners. By consulting throughout this project secondary care clinicians supported the project from its conception, and were prepared when the service went out to tender. It also ensured collaborative working on the patient pathway.

2. To think innovatively in terms of service re-design. For example in this project the continence nurses were already providing a well performing service, and therefore instead of de-commissioning the service and tendering the continence service as a package, it was more effective to supplement the existing service by tendering only for the physiotherapy element.

3. When tendering a service it is important to have an output based service specification to ensure you get the service coverage you want. It also enables potential providers to think creatively and be flexible about what they can supply.

Contact details

Lilian Ethapemi
Continence Nurse Specialist
Central London Community Healthcare NHS Trust

Primary care
Is the example industry-sponsored in any way?