The integrated CKD service comprises of:

• a consultant-led triage service 
• community-based specialist nurse/pharmacist-led CKD clinics, provided by the Royal Free London (RFL) in primary care locations with support from specialist CKD dietitian and occupational therapist.
• an education programme to support CKD management in primary care 
• prompt CKD management advice for primary care. 

Sharing the patient's EMIS record

A key aspect of the service is the consultant's direct access to the patient's EMIS record, helping to inform the clinical decision. It is important to receive explicit patient permission for the sharing of the record.  

Triage outcomes

All referrals will be triaged and a response communicated back to the referring GP within two weeks of submission. The four outcomes following triage are: 

• return to primary care with management advice 
• patient seen in nurse or pharmacist-led community clinic 
• patient referred to diagnostic/general nephrology clinic at Barnet Hospital, Royal Free Hospital, North Middlesex Hospital or Whittington Hospital 
• patient referred to specialist clinic in secondary care. 

Nurse/pharmacist-led community CKD clinic

The community CKD nursing and pharmacist team run autonomous clinics, providing specialist, high-quality, expert care and support for patients and their families with a diagnosis of CKD. They carry out a variety of extended or advanced clinical practices in relation to this and work with the support and governance from the lead clinician and the multi-disciplinary team.

The team is supported by a specialist CKD dietitian and occupational therapist.  

The aim of the CKD service is to delay the progression of patients' kidney disease by managing risk factors and symptoms of CKD through health-related behaviour change, health education and promotion and medicines management.

For patient information leaflets, refer patients to the Keeping Well section of NCL ICS patient-facing website. 

Education: Clinician education sessions

If you would like to arrange a CKD training session for your practice or PCN, email: rf-tr.communityckdservice@nhs.net.

Eligibility Criteria

Inclusions

• Barnet, Camden, Enfield, Haringey and Islington-registered patients aged >18 years with a renal disorder
• Patients where a GP has concerns regarding aspects of managing CKD.
• Refer to the 'Reasons for Referral to Nephrology' section of the NCL CKD clinical pathway for guidance on referral criteria.  

Exclusions

• paediatric patients
• urgent referrals:
  • acute kidney injury (acute renal failure)
  • malignant hypertension
  • hyperkalaemia (K+ >7mmol/L)
  • nephrotic syndrome.

How to Refer

All CKD, Nephrology and Renal referrals in NCL should be submitted via e-RS. For urgent acute kidney injuries, contact the hopsital diectly.