“If you can measure that of which you speak and express it is numbers, you know something about your subject; if you cannot measure it, your knowledge is of a very meagre and unsatisfactory kind”, William Thompson (Lord Kelvin) (1824-1907).
In the same city, 100 years after the death of Lord Kelvin the Scottish Primary Care Collaborative chose (SPCC) CKD as one of their target areas for 2008. Mark Macgregor (Consultant Nephrologist at Crosshouse Hospital, Kilmarnock), tells me that he thinks the focus will be on proteinuria and adding quality to care rather than just a kneejerk response to the low prevalence of 1.8% reported from Scotland in comparison to the other home countries. This low prevalence is thought to relate to delays in systematic eGFR reporting and that in many parts of Scotland, General Practitioners only get the results that they have requested into their EPR systems. As we know, many people with CKD are seen in a variety of secondary care settings because of their associated co-morbidities.
The Scottish Primary Care Collaborative is a programme designed to remodel the way general practice works and The Improvement Foundation (previously known as the National Primary Care Development Team – why do things change their names so quickly?), headed by Sir John Oldham, have assisted with the Scottish programme.
To date there have been almost 500 GP practices participating in the SPCC and their improvement results are impressive. Take diabetes or CHD as examples
I think this is great news for people with CKD in Scotland and it is perhaps a model that can be adopted elsewhere to build on the platform of the visibility that the CKD domain of the QOF has brought to add real value.
Similar approaches are being taken in parts of England. Nicky Coffey (Associate Director, South East Coast, SCG) with Ian John (Consultant Renal Physician, East Kent Hospitals NHS Trust) who have established a formal CKD Network across primary care across the catchment population of East Kent Hospitals NHS Trust. The Terms of Reference make it clear that this Network is about processes and pathways rather than structures.
The percentage of the population with an MDRD eGFR below 60 mmols/min/ 1.73m2 is not the issue. The issue is, of course, the quality of care that can be delivered using the chronic disease management model for registered populations.
A word of caution about measurements. “Not everything that counts can be counted, and not everything that is counted counts” Albert Einstein (1879-1955),