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Gold, incentives and meh

GPs to manage millions of extra CKD cases

By Nigel Praities

GPs will have to manage millions of extra cases of chronic kidney disease when the Government's cardiovascular screening programme is introduced next year, the Department of Health's kidney tsar is warning.

The department is planning new referral guidelines to ensure a greater proportion of CKD cases are managed within general practice, amid fears that renal units would otherwise be swamped with work.

Under the quality and outcomes framework, 3% of patients were recorded as having CKD in 2006/7, whereas the true prevalence is estimated at 8.5%. At least 93% of patients with CKD are set to be uncovered under screening, according to estimates from the National Screening Committee.

Dr Donal O'Donoghue, national clinical director for kidney services, told Pulse that GPs would have to take on the majority of the burden of new cases, because most would be of early-stage disease and not suitable for referral.

‘Very few of those missing millions with CKD have very advanced disease, so what we are going to see is more people identified and a challenge to the system to try and get them to reduce their risk, supported by primary care,' he said. He added: ‘I think we should be looking at referral management.

‘We have an 18-week pathway for CKD which will be published soon and often this will be for secondary care, but it also talks about appropriateness of referral, what tests should have been done beforehand, and is this consistent with NICE guidance?'

The plans for regular vascular checks for everyone aged 40 to 75, announced by the Government earlier this month, include routine eGFR testing for all patients thought to be at risk of CKD.

But Professor Mike Kirby, professor of health and human sciences at the University of Hertfordshire and a GP in Radlett, said there was a risk the plans could ‘break the camel's back', as practices were already struggling with cuts in pay, extended hours and competition from the private sector.

‘We have to be very careful that this comes in a well-structured way and people don't get flooded or snowed under,' he said.

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