Primary care is in the news almost every day, often with negative comments about GP surgeries not being open long enough or not coping with the increasing patient burden. The NHS is stretched and primary care is the first door through which many patients pass. Every day GPs have to deal with an enormous range of diseases from the self-limiting to the life threatening. Unlike many of their hospital colleagues, who work in a specialised area, GPs will be jumping from chest, heart, gynaecological and kidney medicine between each patient consultation.
Patients who historically would have had their care overseen by the hospital due to complexity are now followed up in primary care and it will be common for patients to be on 10 -15 repeat medications. A few years ago this would have been very uncommon.
So how can the NHS England programme help GPs and other primary care clinicians “Think Kidneys”?
The kidneys lie deep in the abdomen in an area called “retroperitoneal”. Unlike a chest infection or a heart attack there is often very little outward sign in the early stages of acute kidney injury (AKI) for the GP or community health worker to see. Therefore awareness is massively important:
- Awareness of those patients at risk
- Awareness of those drugs most likely to cause damage
- Awareness of how to test and measure, monitor and refer if necessary.
All this can only happen if the clinician is “thinking kidneys”. The thinking part of the brain is the cerebrum, hence the title of my blog. NHS England’s programme is looking at defining risk groups and providing educational material for primary care as well as secondary care. This will go a long way to help busy doctors and community health care workers learn more about AKI and when to be especially vigilant.
Patients who have had an episode of AKI need to be made aware of the diagnosis, whether in hospital or the community. Patients in the community are looked after by a whole primary care team and therefore it is important that their records display this so that whoever sees them on future consultations is aware of their increased risk of developing AKI again.
GPs are actively reviewing patients that are at high risk of admission to hospital and many of these patients will also be at very high risk of developing AKI. Patients with diabetes, heart disease and chronic kidney disease (CKD) are reviewed in primary care at least annually, and all these patients are at increased risk of an episode of AKI. The NHS England programme is helping primary care with education packages but also with care plan guidance and providing case studies to promote “think kidneys”.
The programme is also supporting conversations between patient representatives and primary and secondary care so that we can all learn from each other and share good practice. With these resources GPs will hopefully be able to make a difference to the number of patients admitted to hospital with AKI and will be able to manage some within the community, whilst appropriately escalating those at increased risk of more serious damage to the kidney.
I am pleased to be involved with the programme because I know this will help my patients on a daily basis. I know there are many challenges in primary care at the moment but by working with NHS England on this vital programme I can help make it a bit easier for my colleagues to “Think Kidneys”
Sarah Harding
Sarah loves life and to prove it, gets around a bit! A full time GP in Leeds, Sarah has undertaken her professional training in Southampton, Tauranga in New Zealand, Northumberland and Brisbane, Australia. A recent holiday to Nova Scotia has inspired her for more travel.
Sarah is Co-chair of the Risk workstream on the acute kidney injury national programme and has a special interest in diabetes, chronic kidney disease and acute kidney injury.