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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