Health Secretary Andrew Lansley announced last week that chronic kidney disease (CKD) in primary care would be one of the new 11 topics for national clinical audit as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). The CKD audit proposal was led by Hugh Gallagher, Consultant kidney doctor at St Helier hospital on behalf of NHS Kidney Care and the professional organisations from the kidney, general practice and diabetes worlds. The successful proposals were chosen from a total of 39 bids that were evaluated by the National Clinical Audit Advisory Group against explicit criteria. They judged that our early CKD audit would benefit from a national approach to help drive quality improvement. Robin Burgess, Chief Executive of the Health Quality Improvement Partnership said “Clinical audit is very often the single best method of ensuring the patient care that is provided for specific conditions is in line with best practice. Clinical audit is not simply a measurement process, clinical audit is a complete cycle that uses evidence based research, expressed in standards as the base for its improvement: but after measuring compliance with those standards, good clinical audit should always involve a programme of improvement to drive tangible change in healthcare provision”.
This builds on the National Institute for Health and Clinical Excellence (NICE) clinical guideline on CKD which is currently being considered for revision and the NICE Quality Standards in Kidney Disease.
Days later, the Information Centre published the latest Quality and Outcomes Framework data for 2010-11 which shows that now more than 2 million people in the UK are recognised to have kidney disease and are being managed using chronic disease management principles. In England the percentage of people with CKD stages 3-5 who are on practice registers has now risen to 4.3%. An increase of around 50,000 people compared to 2009-10. A relatively small rise given that the expected prevalence of CKD 3-5, from Health Survey England, is closer to 7% but, there is a good story in terms of proteinuria testing and recording. Have a look how your local practice is doing on the Information Centre website. Many GPs, nurses and practice managers have also been telling me that over the last year a great deal of effort has been given to getting the registers right – such as removing incorrectly disease labelled patients with only one low GFR.
So progress is steady and in the right direction. Variance in ascertainment, meaning how likely a person with CKD would be identified and registered in a particular practise, still remains large in comparison to nearly all other disease areas. This probably reflects primary care education, confidence and systems, all of which are being addressed by NHS Kidney Care programmes. It’s a good time to be developing a national audit and that variance shows that further great improvement can still be made in reducing the impact of kidney disease on both vascular events and risk of progression to end stage kidney failure.