GlaxoSmithKline (GSK) today released the results of a poll of 201 GPs that evaluated uptake of the NICE guideline on managing lower urinary tract symptoms (LUTS) in men 1. Of the 46% of GPs who said they were implementing the guideline, 80% reported to have seen a reduction in referral costs. Of those GPs who were not currently implementing the guideline, more than a quarter had high referral costs. 97% of GPs surveyed agreed that more could be done to improve the management of LUTS in primary care.

LUTS are highly prevalent, with up to 30% of men older than 65 experiencing bothersome symptoms.2 The cost of treating the most common cause of LUTS, benign prostatic hyperplasia (BPH),3 alone, is estimated to be more than £180 million each year, 60% of which is incurred in secondary care.4 The NICE guideline was developed to address the need for further clinical advice on how to best diagnose, monitor and treat this large patient population more effectively within primary care.2

The survey found that of the 46% of GPs who were actively implementing the guideline, 41% said they had greater confidence in conducting the necessary diagnostic tests, such as digital rectal examination (DRE), and as a result, their confidence in knowing when to refer to secondary care had significantly improved. In contrast, 33% of those not following the guideline were unsure about when to refer to a specialist, potentially leading to unnecessary and costly hospital referrals.1

Dr Jon Rees, GP with a special interest in urology at Backwell and Nailsea Medical Group, was involved in the development of the NICE guideline and is encouraged that GPs have already experienced benefits as a result of implementation. He said: "The guideline aims to reassure GPs that the majority of men with LUTS can be safely assessed and treated in the community and without the need for costly hospital referrals. These results show the importance of continuing to raise awareness and drive uptake of the guideline to ensure optimal patient care at a time when NHS resources are stretched and there are increasing pressures for savings to be made."

The main reason stated by the GPs polled for not implementing the NICE guideline was lack of education and training. 57% of the GPs polled agreed that further practical guidance would help to improve the management of LUTS in primary care. More than half said they would appreciate more specialised training.1

Emma Malcolm, Chief Executive at Prostate Action, commenting on the survey results said:

"The results show there is clearly a need for more training to be given around the NICE LUTS guideline. At Prostate Action we work closely with clinicians to provide education, but the demand for more support via education and training with the practicing GP community is clear and would also ultimately assist with the Government‟s Quality, Innovation, Productivity and Prevention (QIPP) agenda."

A number of online resources and information on managing LUTS have been produced to support GPs and are now available on the website „health.GSK‟ (see here.)

Prostate Action provides free Masterclasses to assist GPS in the practical management of prostate diseases.

Notes

About the survey

The survey was commissioned by GlaxoSmithKline and conducted by Opinion Health amongst 201 GPs from 28 May to 3 June 2011.

About LUTS and LUTS service provision5

LUTS are highly prevalent, with an estimated 3.2 million men affected in the UK, and can lead to serious and expensive long-term complications if not managed effectively. Urology is the fifth most expensive disease area in the NHS costing £1.6 billion per year.4

The set-up of urology services varies widely across the UK and both the shifting care closer to home white paper and the department of health‟s report „Our health, Our care, Our Say: a new direction for community Services‟ have highlighted opportunities for service re-design that:

- Provide quick access to good quality local care
- Allows urologists to concentrate on patients with suspected urological cancer or complicated disease
- Is more cost-effective in its use of resources

Service redesign to bring urology services into the community is also highly aligned with the QIPP agenda, looking for innovative ways to improve quality, efficiency and ultimately reduce the costs of service provision locally, in line with the national strategy.

References

1. Data on file: NICE LUTS guideline GP survey. Opinion Health. June 2011.

2. NICE clinical guideline 97. Lower tract urinary symptoms in men. Issued May 2010.

3. Rosen R, Altwein J, Boyle P, Kirby RS, Lukacs B, Meuleman E, et al. Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol. 2003;44:637-649.

4. ProState of the Nation. A call to action: delivering more effective care for BPH patients in the UK. GSK 2009.

5. Practical considerations for implementing the NICE Guideline for lower urinary tract symptoms (LUTS). GSK 2011.

Source:
GlaxoSmithKline