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GPs should face scrutiny of acute kidney injury care, says NICE

GP practices could soon be monitored on their care of patients with acute kidney injury, under a raft of new quality indicators put forward by NICE advisors.

The new indicators – for future use in QOF or other local or national performance frameworks – include four new measures of care for acute kidney injury (AKI) patients.

These include checking that GPs keep a register of patients diagnosed with AKI, and carry out medication reviews and renal testing in people who have recently had an episode of AKI.

GPs would also be expected to give patients written information about AKI within a month of diagnosis, under the plans.

NICE said AKI is ‘increasingly being seen in primary care in people without any acute illness’ and that ‘some episodes of AKI may be preventable through patient education’.

The measures are among eleven proposed new ‘GP indicators’ that NICE said could in future be incorporated into QOF or other national frameworks, or used by commisioners in local quality improvement or enhanced services.

They also include two indicators to ensure GPs engage with the National Diabetes Prevention Programme – specifically to create a register of patients with ‘non-diabetic dysglycaemia’, refer these patients for lifestyle intervention and repeat blood glucose tests within a year.

As reported by Pulse, GPs in some areas are already being incentivised on these requirements through local enhanced services, as part of the national programme.

Another proposed marker will measure practices on recording mental health checks in women who have recently given birth, after NICE guidelines that recommended GPs should screen women for anxiety and depression.

NICE said the measure would help more problems to be picked up as some symptoms of mental health problems, such as changes to appetite or sleeping patterns, may be considered normal after giving birth.

Professor Daniel Keenan, associate medical director at Manchester University Hospitals and chair of the NICE indicator advisory committee, said: ‘Indicators are a key part of NICE’s drive to improve people’s lives, enhance the quality of care in the NHS and use its resources wisely.

‘The indicators in this consultation are not final. And I would strongly encourage everyone with an interest in the development of evidence-based indicators to tell us their views. Your feedback will help us finalise the NICE indicator menu in August.’

NICE’s proposed new GP performance indicators - the full list

Practice has set up and maintains a register of all people aged 18 years and over with an episode of AKI in the preceding 12 months

Percentage of patients with an episode of AKI in the past year who have had their serum creatinine, eGFR and either ACR / PCR recorded within three months of diagnosis

Percentage of adults with an episode of AKI in the past year who have had a medication review within a month of diagnosis

Percentage of people with an episode of AKI in the past year who have been given written information about AKI within a month of diagnosis

Practice has set up and maintains a register of all people with a diagnosis of non-diabetic hyperglycaemia

Percentage of people newly diagnosed with non-diabetic hyperglycaemia in the past year who have been referred to a Healthier You: NHS Diabetes Prevention Programme for intensive lifestyle advice

Percentage of people with non-diabetic hyperglycaemia who have had an HbA1c or FPG test in the past year

Percentage of women who have given birth in past year who were asked about their mental health using the Whooley 2 depression questions and the GAD-2 questionnaire, four to 10 weeks after giving birth

Practice has set up and maintains a register of all people on the autistic spectrum

Proportion of women eligible for cervical screening whose notes record an adequate screening test in the previous 3.5 years/5.5 years depending on age

Source - Consultation on potential new indicators

 

Readers' comments (17)

  • not a problem.
    New work so must be properly resourced or it falls to the CCG to get someone else to do it

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  • listen professor....you are wasting your massive intellect at meetings-we need people like you to work 60 hours per week-on the front-line DOING SOME WORK!!And I mean really hard, hard work!!
    don't worry only joking....you get back to the meetings with tea and cake.

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  • How about hospital having to jump through the loops rather than always GPs? Include it in their contracts and them rated just as GPs are.

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  • 'some episodes of AKI may be preventable through patient education'
    Wow.
    Thats diamond hard evidence Mr NICE.
    This is something that perhaps'nephrologists' in 'hospitals' are 'ideally placed for'.

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  • X.Ray

    Most AKI are in the elderly and as a consequence of other major unpreventable health problems. QoFing this is just stupid.

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  • Why can't everyone just leave us alone? That. is. all.

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  • Just Your Average Joe

    NICE said AKI is ‘increasingly being seen in primary care in people without any acute illness’ and that ‘some episodes of AKI may be preventable through patient education’.

    So feel free to get councils and the Health protection agency and the DOH to set up education and advertisements and social media campaigns, get the milk man to deliver education leaflets.

    Once they have AKI it is too late to prevent it - so not the job of the GP to diagnose, then educate in a 10 min consult with 5 other problems and a sick note request.

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  • AKI should go to and stay in secondary care.
    Health Visitors supposed do screening...and tbh I would want to see evidence met criteria

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  • Primary care has become a toxic wasteland, ravaged by this monstrosity NICE. It sits in ambush, and when a lone, one of few still surviving GPs comes near, it snaps its tentacles and injects its poison. It doesn't eat it's pray. Oh no. It passes the corpse to lawyers who hang it high to scare others. Lawyers will also rip the heart out of the dead GPs body and put a single egg in each corpse. When it hatches, the larva will devour the body from within, beginning with the brain. If there isn't enough flesh, the larva will die, and GP is discarded as waste. But if it has it's full, it will go on to develop into another being. And when metamorphosis is completed, a new and fully operational Defensive Medic emerges.

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  • AKI is reasonably interesting as a topic (ie what used to be called 'acute renal failiure',just now couched in terms which infuse some unwarranted mystery) and is an important indicator for potential problems but what the professor has not picked up on amidst the lint in his navel is the fact that in an overstretched service which is understaffed and suffering real despair adding this to the workload simply means everything will just be done more superficially in an attempt to cover this too. This serves no-one and if part of NICEs raison-d'etre is to improve lives then perhaps he should think about the NHS staff whose lives, which are pretty shitty at present, will only be made worse by this imposition.I'm sure most here would agree with the rationale for doing what is asked but the reality is that Primary Care is drowning in a sea of expectations and demands which cannot be met;we need a lifeline and not someone in an ivory tower putting his professorial boots on our heads.

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