Days Matter: Improving Urology Cancer Pathways at Gloucestershire Hospitals NHS Foundation Trust

The Challenge

Patients at Gloucestershire Hospitals NHS Foundation Trust (GHFT) were facing long waits between appointments and tests in the urology cancer pathway. Limited diagnostic capacity and staff shortages, especially among specialist nurses, were causing delays, stress, and frustration. GHFT needed to speed up the process, make better use of staff skills, and ensure patients received timely, high-quality care.

The Approach 

GHFT has introduced several improvements to streamline the pathway:

• Pre-booking the full pathway: Once an MRI is ordered, patients now receive a full schedule of appointments in advance. This avoids delays caused by waiting to book each step and gives patients a clearer picture of what to expect.
• Parallel registrar clinics: Clinics now run side-by-side, allowing more patients to be seen each week.
• Non-medical practitioners (NMPs): From October, trained nursing and clinical staff will begin performing key procedures like flexible cystoscopies and LATP biopsies. This boosts diagnostic capacity without relying solely on consultants.

What Does This Mean for Patients and Staff?

For patients:

• Quicker access to tests and results
• Fewer delays between appointments
• Clearer communication and reduced anxiety

For staff:

• More efficient clinics and better use of time
• Consultants and registrars can focus on complex cases
• Nurse specialists are freed up to support patients more consistently

Impact to Date 

The changes are already making a difference:

• Wait times from MDT meeting to results clinic have dropped by five days
• Pre-booking avoids delays caused by weekend gaps
• Patient feedback highlights improved clarity and reduced uncertainty
• Registrar clinics are running in parallel
• NMP service is launching, expected to deliver 170 extra biopsies and 300 cystoscopies per year
• A new urology hub is in development, set to add hundreds more diagnostic slots annually

Collaboration across the local health system and patient involvement have helped shape these improvements.

Next Steps 

GHFT will:

• Launch and expand the NMP diagnostic service
• Monitor key metrics like diagnosis times and patient experience
• Develop the new urology hub to unlock further capacity
• Continue working with partners across the Integrated Care System (ICS) to share learning and improve other cancer pathways

Project Leads:

• Sydney Walsh, General Manager, Urology, Breast and Vascular, GHFT;
• Kalpna Mistry, Programme Manager, Earlier and Faster Diagnosis of Cancer, NHS Gloucestershire ICB;
• Mr Edward Tudor, Clinical Lead, GHFT