The UK Model for System Redesign and Chronic Kidney Disease Services

  • Paul E. Stevens
    Department of Renal Medicine, East Kent Hospitals University Foundation National Health Service Trust, Kent and Canterbury Hospital, Canterbury, United Kingdom
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  • Donal J. O'Donoghue
    Address reprint requests to Dr. Donal J. O'Donoghue, Department of Renal Medicine, Salford Royal Hospitals Foundation National Health Service Trust, Hope Hospital, Salford, United Kingdom
    Department of Health, England; and the Department of Renal Medicine, Salford Royal Hospitals Foundation National Health Service Trust, Hope Hospital, Salford, United Kingdom
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      The British National Health Service is a closed managed care system. This single health care system for the United Kingdom is funded by the government and paid for by general taxation. All UK citizens are registered with primary care physicians who control access to secondary care services. As a managed care system it should be able to offer integrated care across the whole patient pathway. In reality there are professional, organizational, and institutional barriers to coordination and delivery of care in the NHS. Historically, the United Kingdom has been among the lowest health care spenders of organizations for economic cooperation in developed countries, in absolute terms as well as proportion of the gross domestic product. However, since a Government pledge to place quality at the heart of the NHS and a commitment in 2000 to increase spending on the NHS, the NHS budget has more than doubled—an unprecedented rate of growth, roughly by 7.5% annually in real terms. A quality and outcomes framework has been introduced into primary care to systematically incentivize process measures such as computerization and chronic disease management by establishing practice-based disease registers. The strategic planning for kidney services in England has been developed in this national environment complemented by local research findings and the wider international consensus that has emerged since the publication of the classification of chronic kidney disease in 2002. This program of work has resulted in a paradigm shift from kidney disease being viewed as a secondary care condition to being a primary care priority as part of vascular disease control and management. In the first 2 years of the initiative more than 40% of the expected chronic kidney disease stage 3 to 5 population have been registered in primary care. Kidney disease now is recognized as a public health problem in the United Kingdom, preventative strategies are being integrated into comprehensive vascular risk assessment and management programs, and kidney disease has become an NHS priority area.


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        • National Kidney Foundation
        K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification.
        Am J Kidney Dis. 2002; 39: S17-S31
        • Coresh J.
        • Astor B.C.
        • Greene T.
        • et al.
        Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey.
        Am J Kidney Dis. 2003; 41: 1-12
        • Stevens P.E.
        • O'Donoghue D.J.
        • de Lusignan S.
        • et al.
        Chronic kidney disease management in the United Kingdom: NEOERICA project results.
        Kidney Int. 2007; 72: 92-99
        • Drey N.
        • Roderick P.
        • Mullee M.
        • et al.
        A population-based study of the incidence and outcomes of diagnosed chronic kidney disease.
        Am J Kidney Dis. 2003; 42: 677-684
        • John R.I.
        • Webb M.C.
        • Young A.
        • et al.
        Unreferred chronic kidney disease: a longitudinal study.
        Am J Kidney Dis. 2004; 43: 825-835
        • Roderick P.
        • Jones C.
        • Tomson C.
        • Mason J.
        Late referral for dialysis: improving the management of chronic renal disease.
        QJM. 2002; 95: 363-370
        • Department of Health
        National service framework for renal services.
        2005 ([cited 2009 July 9])
      1. PMIP weekly status report.
        ([2009 February 25])
      2. The quality and outcomes framework.
        ([2009 February 25])
        • Joint Specialty Committee for Renal Disease Royal College of Physicians of London and the Renal Association
        Chronic kidney disease in adults: UK guidelines for identification, management and referral.
        Royal College of Physicians of London, 2006 ([cited 2009 July 9])
        • Burden R.
        • Tomson C.
        Identification, management, and referral of adults with chronic kidney disease: concise guidelines.
        Clin Med. 2005; 5: 635-642
      3. The short CKD eGuide, derived from the UK CKD Guidelines.
        2005 ([2008 April 12])
        • Archibald G.
        • Bartlett W.
        • Brown A.
        • et al.
        UK consensus conference on early chronic kidney disease—6 and 7 February 2007.
        Nephrol Dial Transplant. 2007; 22: 2455-2457
      4. Chronic Kidney Disease.
        ([2009 February 25])
      5. Estimated glomerular filtration rate (eGFR).
        ([2009 February 25])
      6. Ansell D, Feehally J, Fogarty D, Tomson C, Williams AJ, Warwick G: UK Renal Registry Report 2008. Bristol: UK Renal Registry.

      7. CKD forum.
        ([2009 February 25])
        • Richards N.
        • Harris K.
        • Whitfield M.
        • et al.
        Primary care-based disease management of chronic kidney disease (CKD), based on estimated glomerular filtration rate (eGFR) reporting, improves patient outcomes.
        Nephrol Dial Transplant. 2008; 23: 549-555
        • Klebe B.
        • Irving J.
        • Stevens P.E.
        • O'Donoghue D.
        • De Lusignan S.
        • Cooley R.
        • et al.
        The cost of implementing UK guidelines for the management of chronic kidney disease.
        Nephrol Dial Transplant. 2007; 22: 2504-2512
        • de Jong P.E.
        • van der Velde M.
        • Gansevoort R.T.
        • Zoccali C.
        Screening for chronic kidney disease: where does Europe go?.
        Clin J Am Soc Nephrol. 2008; 3: 616-623