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Chronic Kidney Disease

Statement February 2017

Greater Manchester Academic Health Science Network (GM AHSN) and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM) have been working together since 2015. Following a consultation exercise to engage all 13 local CCGs and their primary care practices to identify their key priorities for kidney health, and their broader improvement priorities, we performed an audit of Chronic Kidney Disease (CKD) coding and management in primary care practices across the same footprint to complement the data gathered through the consultation exercise. This data helped us assess the accuracy and management of CKD registers within primary care and identify potential areas for improvement. We discussed the findings from this work with CCG leads from across the Greater Manchester and Eastern Cheshire (GM) region, through individual meetings and a workshop, to explore how improvements could be made in cardiovascular risk reduction/kidney health. Details of each stage of the work can be found here.

This process has highlighted a number of issues:-

  • There is a significant diversity across different CCG areas in relation to the way in which they identify their priorities for improvement, and no single improvement intervention is likely to be accepted with equal enthusiasm by all CCGs and/or practices. Kidney health is often seen as part of a broader priority to implement a holistic approach to the management of cardiovascular disease (CVD) and long-term conditions (LTCs).
  • Significant gaps remain between the number of recorded and estimated cases of CKD stages 3-5 in GM and substantial numbers of patients with CKD are not managed to NICE guidelines (i.e. 28%-35% did not have a test for proteinuria or blood pressure result recorded in the preceding 12 months; extrapolated data suggests that c.17,000 patients across GM have confirmed CKD but are not recorded as having a diagnosis). Our findings were comparable to those from the recently published National CKD audit [1].
  • Challenges in sharing and linking real time data to share information easily and rapidly between primary and secondary care hampers efforts to implement improvement projects across different organisations. These challenges should be progressively alleviated through improved data sharing, including the provision of DataWell, across Greater Manchester.
  • There is a balance to maintain between the need/enthusiasm to make improvements and the current capacity issues within general practice, as well as many other priorities.

Moving forward, both NIHR CLAHRC GM and GM AHSN are keen to ensure that the results of this work feed into the priorities for GM being developing through the Greater Manchester Health and Social Care Partnership. There may be opportunities for the findings of our work to inform the developing GM diabetes strategy[2], and we will ensure that the findings from the audit and consultation are made available to the Strategic Clinical Network staff who are developing this.

We would like to acknowledge the significant number of people who have provided input into the work to date and know that local improvements will continue to be made in this area.

 

[1] See report of the National CKD Audit Part 1, Jan 2017

http://www.ckdaudit.org.uk/audit/national-reports/year-1-national-report/#.WI8UfraLTFQ

[2] See section 5 of the Chief Officer’s report, Jan 2017 http://www.gmhsc.org.uk/assets/04-Chief-Officers-Report-v1.0-TD.pdf