Through the Best Practice UTI & Urinary Catheter Care Forum, there have been reports of patients with long-term catheters that have not been referred for appropriate follow-up. The introduction of ‘catheter registers’, which are to be maintained by individual GP practices, will ensure that all patients discharged from hospital with a catheter have the appropriate plans in place for ongoing management and support.

Baseline Submission

To initiate this metric, GP practices should identify all existing catheter patients from their clinical systems. A clinical report (for SystmOne and EMIS) has already been published to support this, and further guidance can be made available if required. Practices should also check to see if any of the long term catheter patients identified have been referred to the community services (and complete a referral if not).

In addition to forming the basis of a catheter register, this will ensure that any existing long term catheter patients are receiving the appropriate level of support. For consistency, practices may choose to re-code existing catheter patients using the codes below.

At the end of quarter one (and in addition to the standard reporting outlined below), practices will need to submit the following baseline figures:

  • Number of patients with existing catheters (identified from clinical systems);
  • Number of referrals to the community as a result of initial review.

Register Management (from April 2018)

GP practices should utilise hospital discharge summaries to identify patients that have left hospital with a catheter in situ. The following clinical codes should then be used to ensure these individuals are captured on practice registers:

Table 1 / SystmOne Code
(CTV3) / SNOMED CT Code
(Concept IDs)
*Indwelling Catheter / XE0iD
(Indwelling urethral catheter) / 266737003
(Indwelling urethral catheter)
-Urethral catheter / Xa3du
(Urethral catheter) / 34759008
(Urethral catheter)
-Suprapubic catheter / Xa3dh
(Suprapubic catheter) / 286861005
(Suprapubic catheter)
Table 2 / EMIS Web Code
(Read V2) / SNOMED CT Code
(Concept IDs)
*Indwelling Catheter / 8D74.
(Indwelling urethral catheter) / 266737003
(Indwelling urethral catheter)
-Urethral catheter / 7B2Bz
(Urethral catheterisation of bladder NOS) / 410021007
(Urethral catheterisation)
-Suprapubic catheter / 8D76.
(Suprapubic catheter in situ) / 440311000
(Suprapubic catheter in situ)

*Where the catheter type (i.e. urethral or suprapubic) is not clearly referenced in the discharge summary, practices can opt to use the top level code (‘Indwelling urethral catheter’).

*Using the codes above will enable GP practices to report on the number of patients added to their catheter register during a specified period (e.g. quarter 1).

*The codes in the blue columns will automatically map to SNOMED CT codes (although it should be noted that the current mapping is subject to change).

*Note on coding: practices can opt to continue using existing codes, as opposed to the ones above (which have been included in this guidance to support practices to maintain a simple catheter register). However, it should be noted that this metric may include random practice audits across the year, hence it is important to implement a clear system.

In addition to the above, practices will also need to record (as free text or using existing read codes) whether patients have been:

  • supplied with an escalation plan;
  • supplied with a catheter passport;
  • provided with catheter equipment;
  • referred to TWOC clinic;
  • referred to Hertfordshire Community Trust (HCT).

The date and reason for catheter insertion should also be recorded in patient notes. This will enable the community services to manage patients more effectively (including providing a catheter passport where required).

Any instances where the information above (including catheter type) has not been captured in a discharge summary should be reported to the CCG GP Hotline for escalation. When reporting an issue, practices will need to supply the following details:

  • patient NHS number;
  • hospital discharged from (including ward if possible);
  • summary of missing information (as per the checklist above).

It is recommended that GP practices maintain a simple log of all escalations to the CCG (including date, reason for escalation, etc.). This will enable them to complete the quarterly returns spreadsheet.

In addition to maintaining an electronic catheter register, GP practices will need to refer all long term catheter patients to HCT (as per the existing Integrated Community Team referral process). This will ensure that no patients are lost to follow-up.

*Note: it should be evident, from a discharge summary, whether the catheter is long or short term. If this information is not included, the CCG should be notified as per the process above.

*Note: because SystmOne and EMIS Web are not currently interoperable, EMIS practices will need to ensure that the ICT referral form is populated with sufficient information before referring (e.g. date of catheter insertion, reason for insertion, etc.).

If a patient presents for a consultation with a previously un-documented catheter (i.e. there is no record of the practice being informed that the patient was discharged from hospital with a catheter in situ), GP practices will need to add a code to their record and refer to HCT if required. In addition, practices should notify the CCG (via the GP Hotline) of any such cases so they can be raised as a clinical incident. For quarterly reporting purposes, it is recommended that practices utilise the log discussed above to record any such escalations.

Repeat dispensing of catheter equipment (e.g. leg bags) should also be used as an opportunity to identify, code and report previously un-documented catheters still in situ.

Information required for escalation by CCG:

  • patient NHS number;
  • Notification that practice was not informed of catheter insertion;
  • Assumed place of discharge with catheter.

GP practices will also need to document catheter removals (e.g. after a successful TWOC in the community). This can be achieved by using the following clinical codes (and supporting free text where required):

Table 3 / SystmOne Code
(CTV3) / SNOMED CT Code
(Concept IDs)
*Indwelling catheter removed / XE0it
(Indwelling catheter removed) / 266768004
(Indwelling catheter removed)
- Removal of urethral catheter / 7B2B2
(Removal of urethral catheter) / 55449009
(Removal of urethral catheter)
- Removal of suprapubic catheter / 7B2C2
(Removal of suprapubic catheter) / 75325006
(Removal of suprapubic catheter)
Table 4 / EMIS Web Code
(Read V2) / SNOMED CT Code
(Concept IDs)
- Removal of urethral catheter / 7B2B2
(Removal of urethral catheter) / 55449009
(Removal of urethral catheter)
- Removal of suprapubic catheter / 7B2C2
(Removal of suprapubic catheter) / 75325006
(Removal of suprapubic catheter)

*Note on coding: practices can opt to continue using existing codes, as opposed to the one above (which has been included in this guidance to support practices to maintain a simple and reportable catheter register). However, it should be noted that this metric may include random practice audits across the year, hence it is important to implement a clear system.

In order to support GP practices to achieve this aspect of the metric, local provides (including HCT) will be instructed to provide clear, physical confirmation (e.g. discharge summaries) when a catheter has been removed. This will enable practices to monitor and report on catheter removals on a quarterly basis.

Sharing patient records will provision HCT with the ability to directly update patient records (SystmOne only). In turn, this will enable community teams to code when a catheter has been removed (using the tables above). However, HCT will still be expected to provide physical confirmation that a catheter has been removed, and that the appropriate codes have been applied to the patients record. This will enable SystmOne practices to confirm that records have been updated appropriately. It will also ensure consistency across the CCG.

The vast majority of short term catheters will be removed in a TWOC clinic shortly after insertion. Both SystmOne and EMIS Web practices will therefore need to review clinic letters to identify catheter removals, and then code appropriately using the tables above (if required). This will ensure that registers are kept up to date (regardless of whether catheters are short or long term).

Any issues relating to catheter removal notifications should be escalated to the GP Hotline for resolution.

CCG and Local Providers

In addition to ensuring that directly affected providers understand the requirements of this scheme, the CCG will be working with local hospitals to improve discharge processes. It is therefore anticipated that the number of cases requiring escalation to the CCG will reduce significantly over the next twelve months.

The CCG is also prepared to respond to any issues identified by practices, and provide further guidance where requested.

Quarterly Reporting

The following metrics will need to be reported on a regular basis:

Metric / Reporting Frequency / Measurement
Register list size at end of quarter (accounting for additions and removals). / Quarterly / Count
Number of patients added to register during quarter. / Quarterly / Count
Number of patients removed from register during quarter. / Quarterly / Count
Number of escalations to CCG for incomplete discharge summaries. / Quarterly / Count
Number of escalations to CCG for previously un-documented catheters. / Quarterly / Count

Note on coding: the objectives of this metric do not include changing the way GP practices code catheter activity. If practices already have systems in place, they can continue to utilise these for the duration of the 18/19 CFF (assuming they fulfil the reporting requirement’s outlined above). However, it should be noted that this metric may include random practice audits across the year, hence it is important to implement a clear system.

END