Have your say: penile prosthesis commissioning and the future of men’s health surgery

In 2018, NHS England produced a draft service specification proposing how penile prosthesis surgery should be delivered in England in the future. In this document they stated that they would like this procedure concentrated to just four centres in all, each performing approximately 100 cases per year.

In theory, this would probably mean one centre in London, one in the Midlands, one in the North of England and one in the South. There are currently over 30 surgeons offering this treatment in the UK. There is no doubt that further drift of associated work, as well as the surgeons with the appropriate expertise, would follow in subsequent years – meaning that large swathes of the population would need to travel hundreds of miles for male genital surgery in the future. This would equate to an abrupt increase in barriers of access at a time when men’s health care already receives insufficient resources, and when demands and expectations are rising.

In response to this proposal, the British Association of Urological Surgeons (BAUS) convened a meeting of ALL surgeons performing penile prosthesis surgery in the UK. At the meeting we managed to achieve unanimous agreement that there should be centralisation of this surgical work, and an insistence on minimum caseload for surgeons, to ensure that standards and outcomes are optimised.

However, we also felt that four centres was far too few, as in addition to the reasons above:
1. No centre has the capacity to absorb the additional workload without significantly increasing waiting times
2. There is no evidence to suggest that four centres would produce better outcomes than one in each region (9)
3. A number of surgeons in the ‘wrong’ locations would just give up, diminishing the already scarce skill-base in this area.

There is no doubt that under NHS England’s proposals the increasing distances involved, as well as the capacity problems generated, would mean that it would be become more difficult for men in England to access this treatment, and more difficult for many skilled surgeons to continue providing this service.

On the contrary, BAUS proposed a regional centre-based model that would provide equitable geographical access for men across the UK, while creating a centre of excellence performing high-volume andrological surgery in each region. This would mean one centre in each of the North West, North East, West Midlands, East Midlands, East of England, North London, South London, South Coast and South West regions of England – a total of nine centres in England.

Each centre would serve a population of at least five million, generating over 50 penile prosthesis operations per year, and integrated with other associated conditions such as post-prostatectomy incontinence, Peyronie’s disease, etc. These centres would be likely to co-locate with the regional centres for cancer, trauma, specialist services and training, as well as the existing regional networks that already exist in England.

Unfortunately, the recommendation from BAUS, and collective opinion, were not taken on board or incorporated into the adapted Service Specification that has now been posted on the NHS England’s website as part of a public consultation – https://www.engage.england.nhs.uk/consultation/penile-prosthesis-surgery/.

NHS England want to gauge the strength of feeling of the public on this, and no doubt the volume and tone of opinion will carry huge sway when it comes to the eventual decision-making.

We would therefore appeal to all members of the public and professionals who care about the future quality, accessibility and equality of future men’s health services in the UK to go to the NHS England website below and voice your comments.

The consultation lasts eight weeks and ends on the 19th March, and all responses have to posted online on the link below:

https://www.engage.england.nhs.uk/consultation/penile-prosthesis-surgery/

What are your thoughts? Should the BAUS recommendation be accepted or the initial draft service specification from NHS England? Please let us know your thoughts in the comment section below. You can also pass your thoughts on directly to BAUS at  let us at: https://www.baus.org.uk/about/contact.aspx

Comments (5) Add yours ↓
  1. Brian Birch Honorary Associate Professor in Urology

    Good idea and strongly support the idea of one centre being in Southampton which not only had a specialist andrologist (and president of section of andrology)!but the commitment and drive to achieve the stated aims. Operative outcomes are excellent and the team supportive and innovative.

    January 24, 2019 Reply
  2. Trevor Dorkin Consultant Urological Surgeon

    I agree some centralisation of services is needed, but the proposed 4-centre model is a step too far. The response from BAUS is logical, sensible and pragmatic. Patients do not want to travel hundreds of miles on expensive trains for their appointments and treatment. Another unintended consequence of 4 centres is that patients will also have to travel miles if there is a complication as the expertise to treat them in the local (or regional) urology department will be lost.

    February 10, 2019 Reply
  3. Roger Kirby

    Gareth Brown would be grateful if you would take the time to complete the survey through the link provided below. The aim of the survey is to examine current pre-operative and intra-operative practice amongst Penile Implanters in the UK.

    The proposed NHS England remodelling does not directly affect Wales as yet. The survey is therefore completely independent and purely to review current practice. It is a piece of work being undertaken by my current urology ST’s.

    It should take no more than 5 minutes to complete.

    https://cardiff.onlinesurveys.ac.uk/pre-and-intra-operative-practice-amongst-penile-implanters-2

    Many thanks for your help and time,

    Gareth Brown
    Consultant Urologist and Andrology Surgeons

    February 14, 2019 Reply
  4. Gareth Brown Consultant Urologist and Andrology Surgeon

    The proposed remodelling of the UK Penile Inplant Service by NHS England is a step too far. A service based on NHS region is desirable, more practical and easier to deliver to the patients.

    February 15, 2019 Reply
  5. Tim Terry Cons Urologist

    The ‘ 9 centre’ regional model makes sense for NHS England , patients and BAUS . The evidence to support a more restricted number of andrology units offering prosthetic surgery allied to male incontinence , PDS , urethroplasty and penile cancer is hypothetical / subjective at best . If NHS england are really serious in their aims of providing regional services that are high quality for patients , surgeons and hospitals alike why are they seemingly not listening to the specialty service ( BAUS ) ? If the argument is money saving where is the evidence that a 4 centre model is the best deal ?

    February 15, 2019 Reply

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