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GPs to manage more CKD cases under new referral rules

By Nigel Praities

Strict Government-approved criteria for chronic kidney disease referrals could see GPs forced to treat more patients – including those with more severe disease.

In a bid to stem rising referrals, which are overloading hospital clinics and risking trusts' chances of meeting the 18-week target for referral to treatment, PCTs have been told GPs should manage all patients with stage 3 CKD without complications.

41189871The new ‘18-week pathway' stipulates that only patients with an eGFR under 30ml/min should be referred; anyone else will only be considered if they have heavy non-diabetic proteinuria or a rapidly declining eGFR.

The Government's renal tsar, Dr Donal O'Donoghue, confirmed that PCTs may need to consider referral management systems to prevent surges in demand and ensure the 18-week target is met.

He said: ‘PCTs can use the pathway to audit the appropriateness of referrals or empower secondary care to feed this back to GPs. Commissioners can also use the pathway to manage demand.'

Dr Kathryn Griffith, a GP in York and primary care lead for the CKD pathway, admitted the new referral criteria were stricter than Renal Association guidelines but said GPs had become more adept at managing CKD. ‘It is like type 2 diabetes – we don't refer all those patients anymore.'

But Dr Chris Farmer, a consultant renal physician at East Kent Hospital NHS Trust, said the new pathway would not resolve the problem of inappropriate referrals. ‘There are vast numbers of patients with stage 3 CKD and it is very difficult to identify those whose kidney function is declining,' he said.

Research to be presented at the Renal Association conference in Glasgow later this month reveals some units have seen a doubling of referrals since CKD was added to the QOF.

New CKD referral criteria

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