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Specialists prepare to dump kidney workload on GPs

GPs will be forced to take back up to half of their renal patients currently treated by specialists ­ and must brace themselves for many new referrals to be bounced back.

Renal units across the UK are drawing up tough new referral guidelines aimed at forcing

GPs to shoulder the soaring workload from chronic kidney disease.

GPs face having to treat a high proportion of the 10 per cent of patients set to be diagnosed with CKD under the QOF ­ including potentially complex cases.

A Pulse survey of 43 renal departments reveals every single one is predicting a surge in referrals as a result of the QOF. More than 90 per cent are introducing new guidelines aimed at blocking GP referrals judged to be inappropriate.

Guidelines will insist patients are only referred if a low eGFR is in decline for several months or accompanied by factors such as haematuria ­ with GPs first expected to attempt to hit stringent 130/80mmHg BP targets.

Some 85 per cent of renal units plan to shunt back to GPs patients they are currently managing to clear the decks for more complex cases.

Professor Neil Turner, consultant in nephrology at Edinburgh Royal Infirmary, said his department had already seen a 'significant increase' in referrals since the introduction of eGFR in January. 'Many have been dealt with by a letter suggesting management in primary care. In anticipation of the increased number of new re- ferrals we have discharged many stable patients who were under occasional review.'

North Staffordshire Hospital said it would be sending 'up to half' its general nephrology patients back to GPs.

Dr David Ansell, director of the UK Renal Registry in Bristol, said the new guidelines were 'definitely not' an over-reaction. 'Even if you double or triple the number of nephrologists you are not going to be able to cope with the influx from GPs unless most are managed in primary care.'

But GPs said it was 'unacceptable' to block referrals because of lack of capacity and questioned whether they had the expertise to manage large numbers of CKD patients.

Dr John Givans, secretary of North Yorkshire LMC, said: 'We are not in the game of having secondary care dumped on to general practice without additional resources.'

Additional reporting by Anna Hodgekiss

dcressey@cmpi.biz

How renal units are mobilising

100%

expecting increase in GP referrals

95%

seeking to 'more clearly define' GP referrals

100%

introducing new guidelines

85%

planning to send current patients back to GPs

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