Our quality improvement programme for chronic kidney disease eliminated a hospital visit for 80 per cent of patients and reduced the wait time for a specialist opinion from two months to six days.
Chronic kidney disease progresses slowly and is often associated with other long-term conditions. That means many patients are managing a complex combination of symptoms, and their kidney function can decline under the radar until it reaches a critical level.
In 2015, people with chronic kidney disease in North East London were waiting more than two months to see a kidney specialist (nephrologist) after being referred by their GP. When the appointment came, many patients didn’t benefit as much as they expected. They also found it frustrating that the specialist couldn’t access their full GP record and so did not have a full picture of their health.
Specialists felt they were often seeing the wrong patient group – people who would not benefit from further investigation at hospital but instead needed advice and the ongoing support of their GP. But without referring a patient, there was no way for a GP to ask for that advice.
The problem spanned hospitals and GP practices, so our solution spanned both too. First, we made it easier for GPs to proactively manage their patients with poor kidney function and make timely decisions about referrals:
Secondly, we enabled nephrologists at St Bartholomew’s Hospital to view full GP records (with patient permission). The specialist set time aside to review the patient’s record and decide on the best course of action. For some, that would mean a trip to hospital for further investigation. But for the majority (80 per cent) it resulted in expert advice to the GP so they could be managed in the community.
Using the service, the time to receive an expert opinion from a kidney specialist was reduced from two months to six days. For 80 per cent of patients, it eliminated a visit to hospital - particularly beneficial for people managing numerous medical appointments, mobility issues or dementia.
Using our tools, GPs can now proactively manage patients more easily, meaning fewer cases of declining kidney function go unchecked. We have seen improvements in blood pressure management and statin use, and in the future, we hope these will translate into fewer cases of an unplanned start to kidney dialysis.— Dr Sally Hull, Honorary Clinical Reader
Specialists can now see a fuller picture of their patient’s health and make better informed decisions about a course of action. GPs can make equitable decisions about who to refer for a specialist opinion without needing to consider the upheaval of a patient’s trip to hospital, the need for someone to accompany them, or the impact if they don’t attend. With incentives and the support of commissioners, the service makes it easy for professionals to do the right thing.
Year-on-year, the Community Kidney Service allows the local health system to learn from its data. Hospitals and commissioners can identify over or under-referrers and reach out to provide extra training and support.
The service was highlighted as an exemplar in the NHS 10-year plan and NHSX Renal Digital Playbook, and we continue to share the approach with our networks across the country. Our ambition is to enable equitable outcomes for more patients with chronic kidney disease, as well as encouraging responsible use of health data for more effective and joined-up care.
Dr Sally Hull, Isabel Dostal, Crystal Williams, Zaheer Ahmed.
Header image by the Centre for Ageing Better, from their age-positive image library.