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The Renal Association Report: Clinical Affairs Board – March 2010

This report provides an overview of the activities and initiatives undertaken by The Renal Association's Clinical Affairs Board. It highlights their role in policy development, collaboration with other committees and working parties, and their efforts to improve clinical practice in nephrology. The report also includes updates on the UK Renal Registry and the Guidelines Committee's progress in developing guidelines.

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The Renal Association Report: Clinical Affairs Board – March 2010

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  1. The Renal Association Report from the Clinical Affairs Board12th march 2010

  2. Clinical Affairs Board • Created in 2004 • Function: • to contribute to the development of all aspects of local and national policy relevant to clinical practice in nephrology • integrate and plan the work of the: • The UK Renal Registry • The Clinical Practice Guidelines Committee and • The Clinical Service Committee • Influences through the RA but has no power • Meets three times a year

  3. Current membership of CAB • Chair and Clinical Vice President • Kevin Harris from September 2007 • Committee Chairs • Registry: Charlie Tomson • Guidelines: Robert MacTier • Clinical Services: Martin Raftery • 2 elected members of the ExecutivePhil Kalra demitted 2009 Andrew Lewington Liz Lightstone started 2009 • National Clinical Director (ex officio)

  4. Guidelines Committee • RA guidelines • the 28 lead co-authors are on schedule to complete the 14 modules of the 5th edition in 2010. • Website based • Investigating hard copy publication for 60th Anniversary • Invited commentaries on the 3 current KDIGO guidelines • hepatitis C, mineral and bone disorders in CKD and medical management of the renal transplant recipient • The CAB will also provide a commentary on the soon to be published KDIGO AKI guideline.

  5. Guidelines Committee • Links with other guideline development groups • EPS, atypical HUS, oral bowel cleansing agents in renal patients, JBS 3 cardiovascular disease guideline group. • Contrast induced AKI guideline planned with the British Interventional Radiology and British Interventional Cardiology Societies. • Application to NHS Evidence for accreditation of the RA clinical practice guidelines • submitted on the 22nd February

  6. UK Renal Registry The Renal Association UK Renal Registry The Twelfth Annual Report December 2009

  7. UK Renal Registry • Registry will alert Clinical or Specialty Directors to findings relating to mortality in their centre that might deserve further investigation • Request evidence that this finding has been discussed with the Clinical Governance lead and Chief Executive of the Trust in which the centre is based.

  8. CAB workstreams • Home therapies working parties • PD working party – chaired by Edwina Brown • HHD working party - chaired by Dr Robert MacTier & Dr Mark MacGregor.

  9. CAB workstreams • Swine Flu pandemic Briefing and guidance for adult renal units in the UK during an influenza pandemic • Pandemic planning • Dosing adjustments for antivirals

  10. CAB workstreams • Liaison with NICE • Belatacept for the prevention of organ rejection in renal transplantation • Intradialytic exercise for the management of renal failure • Machine perfusion systems and cold static storage of kidneys from deceased donors • On-line Haemodiafiltration for Established Renal Failure • Peritoneal dialysis • Tap water haemodialysis systems for established renal failure • Everolimus in PKD

  11. CAB workstreams • Payment by Results for RRT

  12. CAB workstreams Payment by Results for RRT • NON-MANDATORY TARIFF 2010/11 • Tariffs are based on a session of haemodialysis and a day of peritoneal dialysis • Aim remains to move to a mandatory “best practice” tariff in 2011/12. • Best practice tariff will encourage specific aspects of good practice • haemodialysis via a fistula • providing access to home haemodialysis wherever clinically appropriate

  13. CAB workstreams Payment by Results for RRT • Will renal units lose out if their funding is based on the non-mandatory tariff for 2010/11?

  14. CAB workstreams AKI • Improving the quality of medical and surgical care • News Release • 11 June 2009 • National enquiry calls for better recognition of kidney failure in acutely ill hospital patients • A national enquiry has uncovered systematic failings in the clinical care of patients suffering from acute kidney injury (AKI). The report identifies: • Doctors failing to carry out basic care plans • Doctors unable to recognise acute illness • Organisational deficiencies inhibiting investigation and management

  15. CAB workstreams AKI • RA actively participating in: • Definitions for AKI • Coding • Guidelines for prevention • Guidelines for appropriate referral and transfer • Education • Audit

  16. Turbulent times (Chris Winearls. CD forum 2007) • Financial imbalance in many Trusts • Changing Health Authority structures • Target culture • Capital drought • Commissioning uncertainty – who and how? • Unnecessary re-engineering • Manpower and Training - MMC • Healthcare associated infections

  17. Challenging times ahead Public Sector Net Debt

  18. Challenging times ahead • Improve the quality • There is no more money • Flat cash • Reduce the size of secondary care • Buildings • Staff

  19. Lean Nephrology RA to play a key leadership role – supported by you! A date for your diary: 17th September 2010 Robens Suite Guys Hospital Suggestions to • John Scoble. John.Scoble@gstt.nhs.uk • Kevin Harris. Kevin.harris@uhl-tr.nhs.uk

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