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.

1 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, although practices can opt to develop their own reports. 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 in tables 1 and 2.

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

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

2 Identifying Catheter Patients

2.1 Clinical Communications

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

Table 1: SystmOne / 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 / 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 a discharge summary or clinical communication, 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 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 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 (e.g. leg bags);
  • referred to TWOC clinic (date if known);
  • 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).

2.2 Consultations

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.

2.3 Repeat Dispensing

Repeat dispensing of catheter equipment (e.g. leg bags) should also be used as an opportunity to identify and code previously un-documented catheters. Practices can opt to use the existing clinical report (remembering to change the dates and any other relevant variables), or develop their own. It is recommended that practices conduct this review on a regular basis.

2.4 Community Referrals

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), unless there is clear evidence that this action has been undertaken by the organisation that fitted the catheter. This will ensure that no patients are lost to follow-up.

Any long term catheter patients identified in consultations or via clinical reporting should also be referred to HCT if appropriate.

Note: HCT referral forms will need to be populated with sufficient detail before referring (e.g. date of catheter insertion, reason for insertion, etc.).

2.5 CCG Escalations (1)

Any instances where there is no clear evidence of any follow-up arrangements having been made by the organisation that fitted the catheter (e.g. a referral to TWOC or HCT) should be reported to the CCG GP Hotline for escalation. When reporting an issue, practices should supply the following details:

  • patient NHS number;
  • hospital discharged from (including ward if possible);
  • confirmation that the discharge summary or clinical communication does not contain any evidence to suggest that follow-up arrangements have been made for the patient.

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.

2.6 CCG Escalations (2)

Any instances where a practice identifies that a patient has a catheter, but there is no record of it being fitted (e.g. in previous clinical communications), should be escalated to the CCG GP Hotline for investigation. For the purposes of quarterly reporting, it is recommended that practices utilise the log discussed above to record any such escalations.

Information required for investigation by the CCG:

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

Note:any catheter patients identified during the baseline review do not need to be reported to the CCG GP Hotline (i.e. if there is no previous record of their catheters being fitted).

3 Removing Patients from Catheter Registers

This metric also requires GP practices to monitor and report on catheter removals. Local providers have therefore been asked to ensure that all successful TWOCs are communicated to practices in writing (i.e. via SystmOne tasking, nhs.net, clinic letters, etc.). Given that HCT is using SystmOne, they have been asked to ensure that all catheter removals are coded as per the table below:

Table 1: SystmOne / 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)

Those practices currently sharing with HCT should be able to see and report on this activity. However, there may be some occasions when practices need to code catheter removals in order to ensure that registers are kept up to date (e.g. if a local hospital confirms that a catheter has been successfully removed via a clinic letter).

Note:in addition to coding directly into patient records, HCT has been asked to ensure that written confirmation is provided to practices when a catheter is removed. This will ensure consistency across the CCG and enable practices to confirm that registers have been updated. Any instances where a catheter removal has not been coded correctly should be reported to the CCG GP Hotline.

Until interoperability between SystmOne and EMIS Web has been established, EMIS practices will be required to code catheter removals directly into patient records. The table below can be used to support this:

Table 2: EMIS Web / 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 ones above (which have 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.

3.1 CCG Escalations (1)

Any instances where it is discovered that a patient’s catheter has been removed, but the practice was not informed of this, should be reported to the GP Hotline for further investigation.

Information required for escalation by CCG:

  • patient NHS number;
  • assumed place of catheter removal;
  • confirmation that practice was not informed of catheter removal.

4 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 required.

5 Quarterly Reporting

The following metrics will need to be reported to the CCG via the ‘CFF Monitoring Template’:

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 / clinical communications (as per section 2.5). / Quarterly / Count
Number of escalations to CCG for previously un-documented catheter insertions / removals. / Quarterly / Count