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GPs missing income by not coding proteinuria in CKD, say researchers

GPs may be missing out on valuable QOF payments by not recording the presence of proteinuria in patients with chronic kidney disease, an NHS audit has found.

The audit of 33,000 patients in Greater Manchester found one in six patients with CKD had their kidney function or proteinuria status recorded correctly.

The finding shows that NICE guidance from 2008 that specifies stricter treatment for patients with CKD with proteinuria is not being followed.

In line with NICE guidance, QOF points are awarded for the proportion of CKD patients prescribed an ACE-inhibitor or an angiotensin receptor blocker if they have hypertension and proteinuria.

The audit of GP practice data – carried out by GPs at the in the Chorlton and Whalley Range area of Manchester and exclusively seen by Pulse - found 1,075 patients with CKD.

Of those 16% of CKD patients were coded correctly for eGFR and proteinuria and 66% of patients had their albumin-creatinine ratio checked.

Dr Ivan Benett, a GPSI in cardiology and clinical director for Central Manchester CCG, said their results could mean high risk patients were not getting the treatment they needed and practices were not being paid for managing them under QOF.

He told Pulse: ‘The staging process is pretty complicated and it's not an easy thing to do. We did the audit because we wanted to quantify what we knew was happening anecdotally.'

‘If a patient has eGFR<45ml/min and proteinuria you need to seriously consider putting them on a statin and an ACE inhibitor.'

Professor Mike Kirby, professor of health and human sciences and a GP in Hertfordshire, who helped draft the original CKD QOF indicators, said the figures were partly due to patients forgetting to bringing their sample with them.

He said: ‘It is quite difficult to get urine tests from patients because they forget.'

‘In my view CKD should be treated in diabetes, coronary heart disease, secondary prevention style clinics where specialist nurses work systematically. That's the advantage of QOF, you can employ nurses to manage these patients.'