We explored local priorities to reduce cardiovascular risk and support kidney health for patients in the 13 clinical commissioning groups (CCGs) in Greater Manchester and Eastern Cheshire (the Greater Manchester Academic Health Science Network footprint).
What did we do?
Greater Manchester Academic Health Science Network (GM AHSN) and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM) have worked together to deliver a consultation exercise to engage all 13 local CCGs and their primary care practices to identify their key priorities for kidney health, and their broader improvement priorities. We also performed an audit of Chronic Kidney Disease (CKD) coding and management in primary care practices across the same footprint to complement the data gathered through the consultation exercise. This data helped us assess the accuracy and management of CKD registers within primary care and identify potential areas for improvement. We discussed the findings from this work with CCG leads from across the Greater Manchester and Eastern Cheshire (GM) region, through individual meetings and a workshop, to explore how improvements could be made in cardiovascular risk reduction/kidney health. Details of each stage of the work can be found below:
We began in 2015 with a consultation exercise to engage all 13 local CCGs and their primary care practices to identify their key priorities for kidney health, their broader improvement priorities and what support they thought was needed to achieve their desired interventions. View the stage one evaluation report and executive summary.
We performed an audit of CKD coding and management in primary care practices across the same footprint to complement the data gathered through the consultation exercise. IMPAKT™ (a CKD audit tool) was offered to all 517 practices in Greater Manchester and Eastern Cheshire for the purposes of the audit. It was installed in 312 (60%) of the practices where access was granted. This data helped us assess the accuracy and management of CKD registers within primary care and identify potential areas for improvement. View the stage two evaluation report.
We re-engaged with stakeholders in each CCG to discuss the findings from the previous two stages. The feedback meetings indicated receptivity for a wider event to allow stakeholders from across Greater Manchester to meet and share ideas on how to address cardiovascular risk using data from our audit to inform the conversation. This event was jointly delivered by CLAHRC Greater Manchester and Greater Manchester Academic Health Science Network in September 2016. View the summary notes from the event and event resources.
This process has highlighted a number of issues:
- There is a significant diversity across different CCG areas in relation to the way in which they identify their priorities for improvement, and no single improvement intervention is likely to be accepted with equal enthusiasm by all CCGs and/or practices. Kidney health is often seen as part of a broader priority to implement a holistic approach to the management of cardiovascular disease (CVD) and long-term conditions (LTCs).
- Significant gaps remain between the number of recorded and estimated cases of CKD stages 3-5 in GM and substantial numbers of patients with CKD are not managed to NICE guidelines (i.e. 28%-35% did not have a test for proteinuria or blood pressure result recorded in the preceding 12 months; extrapolated data suggests that c.17,000 patients across GM have confirmed CKD but are not recorded as having a diagnosis). Our findings were comparable to those from the 2017 published National CKD audit
- Challenges in sharing and linking real time data to share information easily and rapidly between primary and secondary care hampers efforts to implement improvement projects across different organisations. These challenges should be progressively alleviated through improved data sharing, including the provision of DataWell, across Greater Manchester.
- There is a balance to maintain between the need/enthusiasm to make improvements and the current capacity issues within general practice, as well as many other priorities.
Moving forward, both NIHR CLAHRC GM and GM AHSN are keen to ensure that the results of this work feed into the priorities for GM being developing through the Greater Manchester Health and Social Care Partnership. There may be opportunities for the findings of our work to inform the developing GM diabetes strategy, and we will ensure that the findings from the audit and consultation are made available to the Strategic Clinical Network staff who are developing this.
We would like to acknowledge the significant number of people who have provided input into the work to date and know that local improvements will continue to be made in this area.