on behalf of all DHBs
SPECIALIST SURGICAL SERVICES –
UROLOGY SERVICE
TIER LEVEL TWO
SERVICE SPECIFICATION
STATUS:
MANDATORY 
Approved to be used for mandatory
nationwide description of services to be
provided.
Review History
Approved by Nationwide Service Framework
Coordinating Group (NCG)
Published on NSFL
Date
28 September 2010
September 2010
Administration review: Urology Service (2001)
Amendments: standard Māori health, entry and exit criteria, support
services, service linkages table, quality requirements, purchase
units and reporting requirements.
August 2010
Added Virtual First Specialist Assessment and purchase unit codes
S00011, S70PRE, S70CANC
Note: Contact the Service Specification Programme Manager, National Health Board
Business Unit, Ministry of Health to discuss the process and guidance available in
developing new or updating and revising existing service specifications.
Web site address Nationwide Service Framework Library: http://www.nsfl.health.govt.nz/
SPECIALIST MEDICAL SERVICES –
UROLOGY SERVICE
TIER LEVEL TWO
SERVICE SPECIFICATION
This tier two service specification for Specialist Surgical Services - Urology Service (the
Service) must be used in conjunction with the overarching tier one Specialist Medical and
Surgical Services service specification. This Service is also linked to tier one Services for
Children and Young People service specification. Refer to the tier one service
specifications headings for generic details on:

Service Objectives

Service Users

Access

Service Components

Service Linkages

Exclusions

Quality Requirements

Elective Services
The above sections are applicable to all service delivery.
1.
Service Definition
Urology Service is the management of patients presenting with disorders of the urinary
tract in both sexes and the male reproductive tract. The level of intervention will depend
upon the individual’s clinical condition, their desire for treatment, the capacity of the District
Health Board, training of medical staff and the level of clinical support.
The Service is provided as an integrated service, which can be divided into:

assessment and follow up

urology – flexible cystoscopy

trans-rectal ultrasound and biopsy

day stay surgery

trans-urethral resection of the prostate

basic endoscopic surgical procedures

elective and acute procedures

extracorporeal shock wave lithotripsy (ESWL)

percutaneous nephrolithotomy (PCNL) / interventional radiology

female urology

paediatric urology

trauma
Specialist Surgical Services - Urology Services tier two service specification August 2010
Nationwide Service Framework
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2.
Service Objectives
2.1. General
The Service will ensure that there is prompt service available for patients presenting with
urgent conditions such as acute retention, urosepsis, renal colic, testicular torsion,
inflammatory conditions of the male genital tract and trauma.
The Service will be responsible for:

stabilisation and onward referral to an appropriate level of care as is required for
stabilisation and definitive treatment of all acute cases from time of presentation to
discharge back to referring medical practitioner

assessment and diagnosis of patients in acute and non-acute context

therapeutic procedures and post procedure management

pharmaceutical prescriptions to include the prescriber’s identification with an agreed
indicator of service location and service

provision of appropriate after hours care to people undergoing day surgery including
arrangements for re-admission where required

an appropriate follow-up and treatment of all patients undergoing surgery in line with
accepted standards of clinical practice

specialist follow-up and rehabilitation including occupational therapy, physiotherapy
and co-ordination of multi-disciplinary activity

follow-up, re-admission and treatment of all patients where complications arise in the
course of treatment by the service, this may include appropriate referral to a higher
level of care

long term follow-up and revision of treatment as required that may include
appropriate referral to other providers

liaison with primary care providers.
2.2. Māori Health
Refer to tier one Specialist Medical and Surgical Services and Services for Children and
Young People service specifications.
3.
Service Users
Eligible people who require assessment and treatment for a medical or surgical urology
condition.
4.
Access
4.1. Entry and Exit Criteria
Refer to tier one Specialist Medical and Surgical Services and Services for Children and
Young People service specifications.
4.2 Time
A level of preparedness must be maintained to receive all appropriate acute referrals on a
24-hour basis and transfer to another facility where appropriate.
Requirements for elective assessment and treatment are set out in the tier one Specialist
Medical and Surgical Services service specification.
Specialist Surgical Services - Urology Services tier two service specification August 2010
Nationwide Service Framework
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5.
Service Components
The management of an individual by the Service involves a complex sequence of
relationships and events. The level of intervention varies according to the individual’s
clinical condition, the qualification /training of medical /surgical staff, and the level of
clinical support available.
The Service provided will include:

consultation, opinion and initiation of appropriate investigations

specialist assessment with a written plan of care to the referrer

referral to another speciality for opinion and/or management

elective and acute surgery

pre-operative assessment, education of patients and obtaining informed consent

endoscopic intervention for diagnosis and treatment

open surgical intervention for diagnosis / treatment

post-operative follow-up

mplex cancer surgery

facilitating continuation of care in the community following discharge

coreconstructive surgery

laparoscopic surgery

spinal injury services

spina bifida.
5.1 Processes
Assessment and treatment will be supported by clinical support services and will include:
appropriate assessment, follow up and treatment of all patients undergoing surgery in line
with accepted standards of clinical practice.
5.2 Support Services
Support services include but are but not limited to the following:




clinical support services such as:
–
laboratory services
–
pharmaceutical services
–
imaging services
allied heath support services such as:
–
occupational therapy
-
physiotherapy
-
social workers
-
district nurses
ancillary services
interpreting services (including sign language)
Specialist Surgical Services - Urology Services tier two service specification August 2010
Nationwide Service Framework
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6.
Service Linkages
Refer to the tier one Specialist Medical and Surgical Services service specification and
Services for Children and Young People service specifications. The Service is required
to establish effective links and working arrangements and cooperation with but not
limited to the following service providers:
Service Provider
Primary Health Care services
General Practitioners, Nurse
Practitioners, District Nurses
Nature of Linkage
Liaison, consultation
and referral
Other health professional
Specialists and registered
medical practitioners
Family Planning and Sexual
Health Services
Consultation and
referral
Community and social services
District Nurses
Liaison, coordination
of services
Consumer support groups
Consumer support
and information
Providers of Disability Support
Services
Referral
Consultation and
referral
Liaison
Collaboration
7.
Accountabilities
Liaison with primary health care
organisations and community
based rehabilitation services
that supports continuity of care
Clinical consultation and referral
services that supports continuity
of care
Clinical consultation and referral
services that supports continuity
of care
Assessment, treatment and
intervention that supports
seamless service delivery and
continuity of care
Effective regional linkages to
ensure patients access
appropriate services
Work collaboratively with
intellectual and other disability
support services and facilitate
access to those services when
needed.
Exclusions
Where people are eligible for services funded under the Injury Prevention, Rehabilitation,
and Compensation Act 2001, they are excluded from receiving the Service through public
funding under Vote: Health.
8.
Quality Requirements
The Service must comply with the Provider Quality Standards described in the Operational
Policy Framework or, as applicable, Crown Funding Agreement variations, contracts or
service level agreements.
Specialist Surgical Services - Urology Services tier two service specification August 2010
Nationwide Service Framework
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Purchase Units and Reporting Requirements
Purchase Units are defined in the Ministry’s joint DHB and Ministry Nationwide Service
Framework Purchase Unit Data Dictionary. The following Purchase Units apply to this
Service.
PU Code
PU
Description
PU Definition
Unit of
Measure
Unit of Measure
Definition
S70001
Urology Inpatient
Services
(DRGs)
Cost
Weighted
Discharge
A numerical measure
representing the
relative cost of
treating a patient
through to discharge.
S70002
Urology - 1st
attendance
Attendance
Number of
attendances to a
clinic/department/acu
te assessment unit.
National Non
Admitted
Patient
Collection
(NNPAC)
S00011
Surgical non
contact First
Specialist
Assessment
– any health
specialty
Written plan
of care
Written plan of care
provided by the
specialist to the
referring GP
NNPAC
S70003
Urology Subsequent
attendance
Attendance
Number of
attendances to a
clinic/department/acu
te assessment unit.
NNPAC
S70005
Urology Cystoscopy
DRG WIESNZ
Discharge. Additional
Information is found in
the NZ Casemix
Framework for Publicly
Funded Hospitals which
gets updated every
year.
First attendance to
urologist or medical
officer at registrar level
or above or nurse
practitioner for specialist
assessment.
Following a request
from a GP or community
based Nurse
Practitioner, a review by
a registered medical
practitioner of registrar
level or above or
registered nurse
practitioner of patient
records and any
diagnostic test results,
development of a
written plan of care for
the patient and
provision of that plan
and other necessary
advice to the referring
GP or Nurse
Practitioner. This does
not include the triaging
of referral letters. The
patient should not be
present during the
assessment.
Follow-up attendances
to urologist or medical
officer at registrar level
or above or nurse
practitioner. Excludes
cystoscopy, lithotripsy
and chemotherapy.
Cystoscopy performed
as an outpatient or
elective daycase.
Procedure
An individual
operative/diagnostic/
assessment
procedure.
NNPAC
Specialist Surgical Services - Urology Services tier two service specification August 2010
Nationwide Service Framework
National
Collections or
Payment
Systems
National
Minimum Data
Set
(NMDS)
5
PU Code
PU
Description
PU Definition
Unit of
Measure
Unit of Measure
Definition
S70006
Urology Lithotripsy
Lithotripsy as an
outpatient or elective
daycase.
Procedure
S70007
Urodynamics
Patients treated for
urodynamic procedures.
Procedure
S70PRE
Urology
Preadmission
visit
Attendance
S70CANC
Urology
Cancelled
Operation
NOT PURCHASED
FOR NNPAC USE
ONLY - preadmission
visit for Urology
procedure paid for as
part of CWD price
NOT PURCHASED
FOR COUNTING USE
ONLY - Urology
cancelled case not
expressly purchased.
An individual
operative/diagnostic/
assessment
procedure.
An individual
operative/diagnostic/
assessment
procedure.
Number of
attendances at PreAdmission Clinic
Attendance
Number of
attendances at PreAdmission Clinic
National
Collections or
Payment
Systems
NNPAC
NNPAC
NNPAC
NNPAC
The Service must comply with the reporting requirements of national data collections
where available.
Specialist Surgical Services - Urology Services tier two service specification August 2010
Nationwide Service Framework
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