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CKD NURSE LED SERVICE: A NEW DEVLEOPMENT FOR PRIMARY CARE
D’Souza, P
Department of Renal Medicine, Royal Devon & Exeter Foundation Trust
INTRODUCTION: Early detection and treatment of Chronic Kidney Disease (CKD) is thought to
delay both the progression of this disease and its associated morbidity, such as cardiovascular
disease. National clinical guidelines offer healthcare practitioners guidance on identifying CKD and
its management, however ambiguity still exists in primary care around caring for people with CKD.
The introduction of Quality Outcome Framework (QOF), and the incentive to detect CKD, can
mean general practitioners are faced with the dilemma of how to manage it once identified. As a
result, this may have contributed to an increase in inappropriate referrals to nephrology services and
escalating outpatient waiting times. The local clinical commissioning group (CCG), agreed to
support the development of the CKD Nurse Service, focused on improving education surrounding
CKD and reducing inappropriate referrals to the secondary care.
METHOD: Through the renal clinician to clinician forum, the CKD nurse service was launched in
the eastern locality of Devon for a period of one year by 2 renal nurse specialists. A clinical
pathway and guidelines were created to assist general practitioners in managing patients with CKD
locally. This included referral into nephrology services. The renal nurse specialists triaged all
referrals, directing them to either a consultant nephrologist or one of 8 locality CKD nurse clinics.
Educational sessions and virtual clinics to were also offered to all 53 practices participating in this
development to enhance clinical knowledge and improve quality and relevance of referral.
RESULTS: In 7 months 256 new nephrology referrals were triaged. See outcome graphs:
Chart 1: Referrals triaged for clinical review
Chart 2: GP and Nurse Education
5
Nephrologists
CKD Nurse
112
139
DNA Nephrology
DNA CKD Nurse
Referrals
returned to GP
Number of sessions
delivered
1
2
30
25
20
15
10
5
0
Educational
Sessions
Virtual
clinics
Actual cost savings to the CCG at the end of 7 months were £ 41,000 for new referrals. This equates
to a reduction of 8.8%. Nephrology appointment waiting times were reduced from 7 to 2 weeks
CONCLUSION: The first 7 months of this service demonstrated that a large number of new
nephrology referrals could be appropriately managed in primary care by a renal nurse specialist.
This development has had a significant impact on healthcare services as well as on people with
CKD. It has facilitated reduced waiting times for nephrologists to see appropriate referrals,
demonstrated a cost reduction to CCGs for nephrology outpatient appointments, and facilitated
improved local access for individuals to specialist services. Further work is required to improve the
quality of referral and engage with practices that have not embraced offers of education. Expansion
of this service will offer equity to all people with CKD across the county.