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The NICE guide on commissioning a service for the management of lower urinary tract symptoms (LUTS) in men, published in late 2010, aims to improve services for the estimated 1 in 4 men in England aged 40 and above who have lower urinary tract symptoms. The guide offers advice on a range of issues, including local needs assessment and opportunities for clinical service redesign. It also signposts to other relevant sources of information, including commissioning guidance, and sets benchmarks to help commissioners determine what an effective service for the management of lower urinary tract symptoms in men looks like.

Underpinned by the NICE clinical guideline on the management of lower urinary tract symptoms in men published earlier last year (CG97), the guide forms part of an interactive commissioning tool, providing data for local comparison against the benchmarks, and is a resource to estimate and inform the cost of commissioning decisions.

The prevalence of lower urinary tract symptoms, such as needing to urinate urgently or frequently, retention of urine, hesitancy and incontinence increases with age. The symptoms can have a considerable impact on a man's physical, mental and social wellbeing. They can also be caused by an underlying health concern, such as a urinary tract infection or prostate cancer. With life expectancy on the rise in Britain, it is vital that the NHS commissions a service that provides the treatment and management techniques that are proven to work best.

The potential benefits of commissioning an effective service for the management of LUTS in men highlighted in the NICE commissioning guide include:

• Improving clinical outcomesand improving emotional and physical wellbeing through accurate diagnosis and effective treatments in line with NICE clinical guideline 97.
• Recognising the importance of conservative managementand lifestyle advice.
• Increasing patient choiceand improving partnership working, patient experience and engagement, with a greater emphasis on patient and carer information and advice.
• Reducing unnecessary referrals to secondary care and inappropriate treatmentby introducing the use of frequency volume charts and by offering alternatives to surgical treatment where appropriate.
• Reducing the risk of urinary tract infections, social isolation and depression by accurate diagnosis and appropriate management of LUTS.
• Increasing clinical and cost effectiveness:By making commissioning decisions based on NICE guidance and accredited information from NHS Evidence, commissioners can ensure that they are using their resources more effectively.

Illustrated with examples of best practice from the NHS, the guide also highlights interventions that should not form part of an effective service. These include not offering homeopathy, phytotherapy or acupuncture, not routinely offering imaging of the upper urinary tract to men with uncomplicated lower urinary tract symptoms at initial assessment, and the recommended discontinued use of some surgical treatments.

Professor Christopher Chapple, Consultant Urological Surgeon and member of the topic-specific Advisory Group which helped develop the guide, said: “Although lower urinary tract symptoms in men are very common, there is currently a great deal of uncertainty and variation in clinical practice in terms of how patients with these symptoms are treated. The NICE clinical guideline on the management of lower urinary tract symptoms in men, on which this guide is based, gives clear recommendations on diagnosis, monitoring and treating the condition in men 18 years and older. Developed with the involvement of primary care clinicians, specialists in the topic area, service commissioners and policy leads, this commissioning guide will help to ensure that those recommendations are embedded in a robust, efficient service that will improve outcomes for the many thousands of men who are diagnosed each year with lower urinary tract symptoms.”

The NICE commissioning guides are one of a number of products introduced by NICE focussing on helping the NHS as it faces up to arguably its greatest challenge yet - to deliver the QIPP (Quality, Improvement, Productivity and Prevention) agenda, whilst facing a squeeze on finances.

While the commissioning guide draws on existing NICE recommendations, it does not constitute formal NICE guidance and is intended as a tool to help the NHS improve patient care through effective commissioning of services.

Notes to Editors

About the commissioning guide

1. Read the NICE guide on commissioning a service for the management of lower urinary tract symptoms in men.

2. The guide is one of five commissioning guide published by NICE during the last 6-months - the others being:

• Quitting smoking in pregnancy and following child birth
• Biologic drugs for the treatment of inflammatory disease in rheumatology, dermatology and gastroenterology
• End of life care for people with dementia

and

• Paediatric continence service

3. Read more about the 35 NICE commissioning guides published to date.

About NICE

4. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

5. NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS

6. NICE produces standards for patient care:

• quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
• Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

7. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.