Black Country and West Birmingham CKD Project

An innovative collaboration between general practice and hospital kidney specialists is planned for the Black Country and West Birmingham “Integrated Care System”. The aim is to improve early detection of chronic kidney disease (CKD) and to facilitate better patient care. We hope that this will reduce the number of patients that go onto develop serious complications of CKD, such as progression to kidney failure, heart attacks and strokes.

The Pilot CKD Project involves:

  1. Special computer searches to identify patients registered at participating GP practices for further evaluation, including those with:
    • Unrecognised CKD
    • Known CKD and rapidly deteriorating kidney function
    • Known CKD and risk-factors for developing worsening kidney function in the future
    • Known CKD but not on all recommended treatments (as per NICE national CKD guidelines)
  2. New “Virtual CKD clinics”, where GPs can refer patients requiring additional input to kidney specialists for “advice and guidance”. Hospital specialists will be able to remotely access patient GP medical records to undertake a prompt “virtual” review. Some patients may remain under the care of their GP, with a well-defined management plan from the specialist, or alternatively, some patients may require a traditional hospital outpatient review.
  3. A structured program of CKD education will be carried out for doctors, nurses and pharmacists that work at local GP practices to help increase their knowledge and confidence in caring for patients with CKD.
  4. Regular reports will be produced for participating GP practices, demonstrating how well they are doing at identifying and managing patients with CKD and how this has changed over the course of the project.

We are working together with a large team of NHS managers, kidney specialists, GPs, nurses and other allied health professionals in the ‘Black Country and West Birmingham Integrated Care System’ to set up, run and evaluate this project pilot. If successful, there is potential to roll out similar initiatives nationally.

The patient voice is critical to our project evaluation process. At this stage we are specifically interested in:

  • Patient feedback on our project proposal and any concerns that you may have about the proposed ‘model of care’.
  • Participation in our ‘patient advisory group’, for ongoing project steer and supervision
  • Co-production/feedback on patient-facing material e.g. patient letters, project poster and project information sheets.
  • Co-production/ collaboration on design and evaluation of “patient surveys”, aimed at exploring patient experience and feedback.

We are interested in all patient voices, especially those from ethnic minority communities, as our local population is very multi-cultural and diverse.

If you would like to get involved in this in any way or would like further information, please contact Dr. Javeria Peracha via email javeria.peracha@nhs.net by Monday July 19th 2021.

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