Tuesday, 18 December 2007

Review and update of the specialised renal services definition

Following the Carter Review of commissioning arrangements for specialised services May 2006 it was agreed that the specialist services definitions set would be updated. We are currently using the second edition produced in 2002 which covers 35 definitions including renal services. So an update to bring the definitions in line with the Renal NSF (the KDOQI nomenclature and the “eGFR” era) makes eminent sense.

The purpose of updating the definition is to produce a set of classifications (ICD and OPCS codes plus text where codes are lacking/insufficient) to enable providers and commissioners to identify and cost specialist service activity. It is important to recognise that the definitions are not service specifications or descriptions of best/evidence based practice or service models. Normally, specialist services are those services where the catchment planning population is greater than 1 million. In other words, these services would not be provided in every district general hospital.

The Renal NSF recommends that preparation for replacement therapy, dialysis and transplant services are best commissioned through a “network” approach in order to ensure equity of access and cohesive planning responsive to the needs of the whole community. The natural population for such effective planning remains in excess of 1 million and may more typically be covered by a Strategic Health Authority (SHA). The Specialist Commissioning Groups (SCGs) are co-terminus with the SHAs and the need to plan for increased dialysis capacity was flagged to the SCGs in the recently published Operating Framework.

Clearly the pathway for patients with CKD involves elements of care which are best delivered at local level and there needs to be clear lines of accountability to ensure that early kidney disease management is provided in line with the principles laid out in Part 2 of the Renal NSF. Acute kidney injury and the “conservative management pathway” also need to be clearly defined for the same reasons.

The unanimous view of the Renal Association and of the National Kidney Federation is that renal services should remain included within the specialist services national definition set. Clearly the update of the specialised commissioning definition links with the current PbR project and with the coding initiatives including the renal SNOMED exercise and the review of the HRGs. They are all important pieces of the jigsaw that, when in place, will enable us to translate between clinical activity and financial returns.

We will be working to update the specialised definition for renal services over the next couple of months. I have asked Kevin Harris (Clinical Vice President of the Renal Association) and Bob Dunn (Patient Advocacy Officer of the National Kidney Federation) to help with this task. I would also welcome the views and comments of individuals – if you would like to contribute please contact me.