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Action welcomed on Renal NSF

Renal NSF Part 1 - Implementation

NKF welcomes action on Renal NSF (NB: The following first appeared in the Spring 2005 edition of 'Kidney Life', the magazine of the NKF)

Nearly one year after its publication, major steps are being taken to ensure that the standards of Part One of the National Service Framework (NSF) for Renal Services become more than a set of promises.

Implementation Toolkit for Commissioners

Commissioners from Primary Care Trusts (PCTs) and specialising commissioning teams now have a 'toolkit' from the UK Department of Health that aims to provide practical advice, guidance and support in implementing the NSF and developing local service strategies. ‘The Implementation Toolkit for Commissioners’ (click here to view a PDF copy, 20 pages, 654 Kb) was produced by a committee of commissioners and doctors, chaired by NKF Advocacy Officer Bob Dunn (in this instance representing patients as an individual rather than on behalf of the Federation).

The bulk of the NSF will be implemented over the next 10 years, but the toolkit includes advice for commissioners on steps that must be taken by 2006 including:

  • Use of national data to support planning and identification of local priorities including the needs of black and minority ethnic groups
  • Continued expansion of haemodialysis capacity
  • Joining the Renal Association's UK Renal Registry (click here to find out more about the Renal Registry) and involvement in national and comparative audit
  • Implementation of the National Institute for Clinical Excellence (NICE) appraisal on assessment for home dialysis
  • Implementation of the NICE appraisal on immunosuppresive therapy

NKF Chief Executive Tim Statham said: “The NKF has ensured that throughout this whole process the NSF itself, and now the implementation documents, have been publicised and made available on the NKF website. It is now up to all KPAs and individual kidney patients to read and understand what the NSF proposes as minimum standards of treatment, and then to consider whether those standards are being met locally. If they are not, then patients (probably through their Kidney PatientAssociations (KPAs)) should bring this to commissioners’ attention so that action can be taken within hospitals and units to raise performance up to NSF standards. Nothing less is acceptable.”

Multi-professional Criteria for Monitoring Implementation of the Renal NSF

There is also detailed advice for renal units on how to meet NSF standards in the draft ‘Multi-professional Criteria for Monitoring Implementation of the National Service Framework for Renal Services’ (Click here to view Final version released May 2005 - PDF on the British Renal Society website). This detailed document was developed by the British Renal Society (BRS), which represent all professional renal groups, and has been published by the BRS and Kidney Alliance. NKF Co-Chairman Gary Lloyd served on the Editorial Panel for the Criteria, and other members of the NKF also made important contributions to the document.

Writing in a preface to the Criteria, NKF Co-chairmen Gary Lloyd and Michael Hill comment: “The NKF campaigned hard, through the Kidney Alliance, for a National Service Framework for Renal Services. We were pleased to be intimately involved in its preparation and warmly welcomed its publication in January 2004. At the same time we expressed our concern that, in keeping with the evolution of Government policy from centrally set targets to local decision making, the Renal NSF lacked the ‘measurables’ necessary to benchmark the service... What is missing is an interpretation of its vision and broad recommendations by patients and professionals into local applicable measures and targets. The BRS was quick off the mark to set about this task.”

Guidelines for Identification, Management and Referral of Adults with chronic Kidney Disease

The NKF has also been involved in the preparation of draft evidence-based ‘Guidelines for Identification, Management and Referral of Adults with chronic Kidney Disease (CKD)’, which were instigated by the Renal Association and the Royal College of Physicians and developed jointly with other professional bodies, such as the Royal College of General Practitioners. The first CKD guidelines specially written for the UK, the document sets out the evidence supporting the early identification of people with chronic kidney disease to prevent progression to end-stage renal failure (ESRF), and emphasises the importance of early referral to a nephrologist in order to improve outcomes for people who need dialysis and transplantation.

Tim Statham commented: ‘Although still in unfinished form, the NKF has been asked to publish the draft for patients to comment upon. This we have done (Click Here to view the draft documents - but please note the deadline for comment has now passed). Part 2 addresses early early detection and prevention of kidney disease and as such must expand healthcare to identify the many ‘undiscovered’ renal patients before they develop ESRF, in the hope that this can be prevented.

The draft CKD guidelines recognise that this task will involve GPs and that patients with early signs of kidney malfunction may be treated and maintained without referral to specialist nephrologists. When reading this document all patients need to realise that the current 40,000 ESRF patients will remain under renal service care, but that the many thousands of early-stage patients - probably currently unaware of their condition - will be maintained outside usual renal environs’.