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GPs stopped from referring children for specialist UTI treatment

Exclusive A specialist UTI service that was closed following a review in 2015 is to reopen in April, but GPs will be barred from referring children, Pulse has learned.

The Whittington LUTS service in north London – the only one of its kind in the country – was closed by the trust after a patient suffered organ failure as a result of an antibiotic prescribed at a higher than recommended dose.

Whittington Health Trust and Islington CCG have agreed a timeline for the new adult-only joint service with UCLH, which members of the trust said could open as early as April, but offered no succession plan for children.

But GP experts said that such a service had previously helped children with chronic UTI, who would otherwise be suffering in pain for years, while Professor James Malone-Lee – who runs the service – said that this means doctors are ‘prohibited from providing the specialist knowledge to the NHS’.

The service, pioneers a unique a treatment of high doses of antibiotics to chronic and recurrent UTI patients.

But a spokesperson for Whittington Health Trust stold Pulse: ‘It is nationally recognised best practice that outside primary care, children should be managed by trained paediatricians in services and environments set up for the management of children.

‘Whittington Health does not have paediatric consultants specialising in the management of urinary tract conditions. The existing commissioned pathway for this group of children is referral by their GP to the specialist paediatric centres within their areas.’

Whittington Trust has no current plans to recruit a paediatrician to reopen the service for children, and hopes to develop the pathway to Great Ormond Street.

But patient groups and experts say the children need the service, and GPs are left working with ineffective guidelines and little option for referrals and treatment.

Dr Cat Anderson, a GP in North Staffordshire with a special interest in urogynaecology, said that the failure to reopen the service to children means for GPs ‘there is more uncertainty and nowhere to turn, with a very tricky cohort of patients… It’s really difficult, because we’ve got patients in pain now.’

She said that GPs struggle to treat these ‘revolving door’ chronic UTI patients: ‘Acute UTIs compared to chronic UTIs, they’re different beasts, different diseases.

‘Traditional testing methods just aren’t good enough, and the type of testing that the NHS employs, it serves the acute UTIs, it doesn’t really serve the chronic UTIs, and actually it provides false reassurance to the clinicians.’

Culture tests frequently miss chronic UTIs and short antibiotic courses fail to clear the infection, she added.

Professor Malone-Lee, speaking to London councillors at a health scrutiny meeting on January 26, said: ‘I know how to treat these patients, both adults and children and the children in particular are easy to treat safely and successfully.’ He said he will publish 12 peer-reviewed studies in the coming weeks, and added: ‘My concern is that we have been prohibited from providing the specialist knowledge to the NHS that we hold for nearly two and a half years.’

Kate Dwyer from the Chronic Urinary Tract Infection Campaign (CUTIC) said: ‘Fundamentally, there is something wrong about removing a care pathway that works for children, shutting it down and not providing an alternative.’


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