Somerset NHS Foundation Trust: Nurse-Led Triage and One-Stop Pathways for Faster Urology Cancer Diagnosis
The Challenge
Somerset NHS Foundation Trust (SFT) was facing delays in its urology cancer pathway, making it difficult to meet national Faster Diagnosis Standard (FDS) targets. Staff shortages, especially among consultants, and fragmented processes meant patients often waited too long between appointments and tests. These delays increased anxiety for patients and added pressure on clinical teams.
The Trust needed to streamline the pathway, reduce unnecessary steps, and make better use of its workforce to improve speed and quality of care.
The Approach
Somerset has introduced a nurse-led triage model that’s transformed how patients move through the pathway:
- Nurses now triage referrals directly, sending patients straight to MRI, outpatient review, or bladder pathway, cutting out unnecessary appointments and delays.
- Same-day triage rates increased from 34% to 55%, and triage within 48 hours rose to over 81%, saving patients an average of 3.7 days.
- MRI results are now managed by nurses, meaning patients don’t need extra appointments just to discuss biopsy plans, saving over 420 outpatient slots a year.
- Navigators now deliver benign results by phone, reducing the need for consultant follow-up letters and freeing up time for complex cases.
- Registrar clinics run in parallel, increasing the number of patients seen.
- Same-day pre-op slots for bladder cancer patients have been introduced, and a new one-stop bladder pathway (flexible cystoscopy and ultrasound in one visit) is launching in November.
What Does This Mean for Patients and Staff?
For patients, this means:
- Faster access to tests and decisions
- Fewer appointments and less waiting
- Clearer communication and reduced anxiety
For staff, it means:
- More efficient use of time and skills
- Consultants and nurse specialists can focus on complex cases
- Improved team morale and service sustainability
Impact to Date
The changes are already delivering results:
- FDS compliance projected to reach 74.2%, the highest ever for Somerset’s urology service
- Over 550 outpatient appointments saved on the prostate pathway
- Over 300 hours of consultant time freed up
- MRI access improved with an additional scanner
- More patients directed to telephone clinics for low-risk results
Staff report better control over the pathway, and patients say communication is clearer and the process feels more efficient.
Next Steps
Somerset NHS FT will:
- Launch the one-stop bladder pathway in November
- Continue refining nurse-led triage and navigator roles
- Monitor key metrics like diagnosis times and patient experience
- Address theatre capacity challenges
- Share learning across SWAG and explore regional standardisation of triage and diagnostic protocols
- Continue working with GPs to improve referral quality
Project Leads:
- Rosie Edgerley, Cancer Programme Manager, Somerset NHS FT.
- Neil Trent, Urology Clinical Lead, Somerset NHS FT
