Transcript Report Clinical Affairs Board

Report
Clinical Affairs Board
Clinical Director’s Forum
Kevin Harris
7th March 2008
Clinical Affairs Board

Created in 2004
 Function:
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
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:
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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
Current membership of CAB

Chair and Clinical Vice President
 Chris Winearls until August 2007
 Kevin Harris from September 2007
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Committee Chairs
 Registry:
 Guidelines:
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Charlie Tomson
David Wheeler until to Nov 2007
Robert MacTier from Nov 2007
 Clinical Services: Kevin Harris until Sept 2007
Martin Raftery from Oct 2007
2 elected members of the Executive
J Kwan (Phil Kalra from 2008)
L Goldberg (Andrew Lewington from 2008)
National Clinical Director (ex officio)
Guidelines Committee

COMPLETION OF 4th EDITION OF
CLINICAL PRACTICE GUIDELINES
TOPIC
STATUS
CKD
Complete 2007
Haemodialysis
Complete 2007
Complications
Complete 2007
Medical Transplantation
Draft posted Jan 2008
Acute kidney injury
Draft posted Jan 2008
Guidelines Committee
THE REDESIGN OF MODULES FOR THE
5th EDITION

Subdivide modules into component parts giving a total
of 15 modules.
 Lead author to draft the new module/next update in
consultation with the second co-author, involving other
experts as necessary.
 The second author becomes the lead author for the
next update in 2011/2012 and works with a new coauthor
 Liaison with international guideline development
groups KDIGO, KDOQI, CARI and EBPG etc
Guidelines Committee
Planned Modules for 5th Edition
Module
number
UK Renal Association Clinical Practice Guideline Modules
(2008-2010)
Module Leads
Date of final version of 4th
Edition on RA
Date of update
or new CPG
1a
Detection and management of CKD stages 1-3
Maartan Taal, Mark MacGregor
Apr 07
Mid 2009
1b
Investigation of haematuria
Lawrence Goldberg, John Kelly (BAUS)
(in progress)
Mid 2008
2a
Cardiovascular disease in CKD
Michael Cassidy
11.12.07
Mid 2009
2b
Mineral metabolism in CKD Stages 3-5
Michael Cassidy, Simon Steddon
11.12.07
Early 2010
2c
Nutrition in CKD Stages 4-5
Colin Jones
11.12. 07
Late 2009
2d
Anaemia in CKD Stages 4-5
Donald Richardson
11.12.07
Late 2009
2e
Infection control in the renal unit
Colin Geddes, Neill Duncan
(in progress)
Late 2008
3a
Planning, initiation and cessation of renal replacement
therapy in CKD Stages 4-5
Ken Farrington, Graham Warwick
(in progress)
Early 2009
3b
Haemodialysis (CKD Stage 5H)
Robert Mactier, Cormac Breen
Mar 07
Mid 2009
3c
Peritoneal Dialysis (CKD Stage 5P)
Simon Davies, Graham Woodrow
May 07
Mid 2009
3d
Vascular access (CKD Stage 5H)
Richard Fluck, Mick Kumwenda
(in progress)
Early 2009
3e
Peritoneal access (CKD Stage 5P)
Martin Wilkie, Badi Shrestha (FRCS)
(in progress)
Early 2009
4a
Evaluation of the kidney transplant candidate in CKD
Stages 4-5
Chris Dudley, Paul Harden
Feb 08
Early
2010
4b
Medical management of the kidney transplant
recipient (CKD Stage 5T)
Alan Jardine, Richard Baker
(in progress)
Late 2008
5
Acute Kidney Injury
Andrew Davenport, Paul Stevens
Mar 08
Early 2010
CAB workstreams

18 week pathways (www.18weeks.nhs.uk)
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General nephrology
Live donor work up
Liaison with BAUS to ensure consistency over
haematuria guidelines
 PD access working party – chaired by Dr
Martin Wilkie
 Briefing and guidance for adult renal units in
the UK during an influenza pandemic
CAB workstreams
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Liaison with NICE
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CKD – Kevin Harris and Lawrence Goldberg

Due out for consultation 11 March - 6 May 2008
home HD guidelines
 Pregnancy and hypertension
 Machine perfusion of kidneys
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Specialised Services Definition set

Martin Raftery and Hugh Cairns
CAB workstreams
 Payment
 RRT
by Results
indicative tariff planned for 2009/10
 mandatory for 2010/11
 Outstanding issues:
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incentivising quality
avoiding perverse incentives
Ongoing workstreams
Year before dialysis
 Supportive and Palliative care
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Turbulent times (Chris Winearls. CD forum 2007)
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Financial imbalance in many Trusts
Changing Health Authority structures
Target culture – 18 week pathway
Capital drought
Commissioning uncertainty – who and how?
Unnecessary re-engineering
Manpower and Training - MMC
Healthcare associated infections
Emerging political support?
Speech on the NHS
7 January 2008

“So there will soon be check-ups on
offer to monitor for heart disease,
strokes, diabetes and kidney disease”