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GPs will be expected to routinely screen hypertensive patients for early signs of chronic kidney disease under a national service framework for renal disease released this week.

The NSF outlines new 'quality requirements' covering prevention, early detection, investigation and treatment of chronic kidney dis- ease, and jointly agreed palliative care plans.

Health minister Rosie Winterton said 'improvements in primary care' should play a major role in identifying and managing the estimated 2.5 million people with CKD, as most did not have symptoms.

The Government expects GPs to routinely identify and assess people at 'increased risk of developing undiagnosed chronic kidney disease'.

To improve management, GPs should refer patients to specialist renal services 'at an appropriate stage to optimise outcomes', and manage BP, cardiovascular disease and risk, and urinary tract problems in patients with CKD.

GPs will be expected to work with renal teams, palliative care specialists and community staff over end-of-life issues and pain reduction.

But GPC negotiator Dr Peter Holden said NSFs were 'statements of best practice, not what we have negotiated'.

Dr Peter Ingham this week opened the doors on what he believes is the country's first kidney dialysis unit to be based in a GP practice.

Dr Ingham and his partner Dr Harj Dau are training in nephrology and will oversee the unit, which will be staffed by specialist nurses.

Dr Ingham, a GP in Sutton Coldfield, Birmingham, said the practice had received 'very positive feedback' from patients about the new clinic. It has five dialysis beds to serve 25 patients. A consultant nephrologist is available for telephone support and a registrar will visit once a week.

The outreach clinic is funded by Birmingham Heartlands and Solihull NHS Trust. Dr Ingham said: 'Dialysis is still organised by the nursing staff but patients no longer have to travel 15 miles. '

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