Annual Report 2022-3

Key achievements

Developed and launched ‘LKN CKD Early Identification & Optimisation Pathways,’ and ‘Coding CKD in Primary Care Guidelines.’  Successfully integrated these into official ICS guidelines across London.

Collaborated with NWL ICHP AHSN and Discover-NOW team to transform the CKD care pathway.  Currently rolling out tested solutions at scale in NWL.  

Secured £250k funding for South London Pilots.

Hosted national CKD webinars and bespoke educational sessions to support implementation of early CKD identification, coding and optimising care.

Secured 7 places at the SEL Scale & Spread Academy to professionally develop the CKD Prevention Team and facilitate implementation of the LKN Clinical Pathways.

Supported ICSs to achieve a confirmed formulary status for Dapagliflozin for the treatment of CKD.

3 oral presentations at UK Kidney Week by the CKD Prevention Team.

Key challenges

Developing engagement and communications strategy.

Slow progress with establishing patient involvement.

Workstream members and primary care had reduced capacity to engage due to competing demands/priorities.

Key achievements

LKN Transplant Collaborative launched in January 2023.

Cardiac assessment, vascular assessment and PKD work-up pathways signed off and being implemented across London.

LKN Team working collaboratively with charity partners GOLD (Gift of Living Donation) to increase living donation transplants in black kidney patients.

London-wide pharmacy guidelines for use of Imlifidase developed and signed off for use across the Capital.

Two patient focus groups held to generate feedback on the Mutual Aid scheme.  Agreed actions will be implemented in 2023-24.

Current deceased donor pathway for transplanting and referring centres mapped at in-person events.  Full finding will be reported and acted on in early 2023-24

Key challenges

Transition to LKN Transplant Collaborative from NHSBT Pan-Thames Collaborative resulted in short pause in work plan.

Key achievements

LKN Guideline for reimbursement of home therapies utility costs completed and implemented in most London renal units.

PD nursing workforce mapped across LKN renal centres and presented to lead nurses and pan-London PD MDT meeting with plans to support gap analysis within each renal centre.

PD training model with key recommendations completed, presented to Unit Clinical Directors and shared with units to promote local QI projects to implement.

PD training model with key recommendations completed, presented to Unit Clinical Directors and shared with units to promote local QI projects to implement.

Key challenges

Renal units unable to meet timescales to  deliver solutions to reduce peritonitis rates.  Work will continue into 2023-24.

Approach to mitigating against small and transient PD Nursing workforce complicated by competing demands on unit level resources.  Will be continued in 2023-24.

Delay in implementation of home therapies reimbursement guidelines in a minority of units.

Difficulties implementing PD workforce (nursing) recommendations to co-create in –house training approach to date. Ongoing with new targets for delivery in 2023-24.

Key achievements

Timed pathways for planned and unplanned starts developed and signed off by all London units.  Agreed QI priorities at units as a result.

Pathway metrics to show issues and progress with improvements agreed, with plans to start reporting in 2023-24.

MAGIC (Managing Access through Generating Improvements in Cannulation) programme implemented across London, with data showing improved needling technique and patient experience as a result.

Piloted use of Cerner-based system to accurately track patient waiting times across the VA Pathway at Barts.  Highlighted improvement opportunities in current pathways and resulted in changes in practice.

Key challenges

Clinician capacity has limited engagement in developing and implementing local QI plans.

Cost to develop Cerner Millennium module for VA for use across London has proven prohibitive to date.

MAGIC programme has now been discontinued by the National Team, leaving a gap in training opportunities, particularly in satellite units.

Key achievements

Comprehensive Young Adult pathway  completed, including streamlined transition from paediatric to adult services. Provided clarify of required make-up of YA workforce to deliver the pathway.

SpR  confidence to meet YA’s needs self-assessed in an online questionnaire.  Current and self-identified training needs identified.  

User service experience audited in one  renal centre.  Result mapped to SpR questionnaire results, with clear parallels between the two identified.

Metrics to effectively measure current practice and performance agreed in Steering Group and with Clinical Information Group.

Key challenges

Local financial resources focused on the YA cohort and local business cases to respond to the demands of the YA service. 

Long-standing under-resourcing of YA services  makes implementation of identified priorities more difficult.

No YA data currently collected or reported, with no national require for such at present.

Key achievements

Developed a Supportive Care Pathway and an Advanced Care Pathway for use across London.

Developed an education module for health care professionals in response to self-identified lack of confidence in discussing Supportive care and Advanced Care Planning.

Began a process of Peer review visits with each unit to support QI priority identification, against Pathway.

Agreed a clear data set, with agreed definitions agreed for the first time.

Develop a set of 4 patient information booklets to support conversation about Supportive Care and End of Life Care, with patient involvement in their development.

Key challenges

Competing priorities delayed speed of delivery of some items.

Key achievements

Continuing working with ICS teams to develop aLKN PPIEG developed to support patient partnership within the LKN and its work. 

Patient involvement opportunities launch November 2022.

Patient representation in the majority of  clinical workstream and one advisory group with a patient representative support group in progress.

Patient focus groups held on various topics including Mutual Aid for transplantation and CKD Prevention pathways.

LKN patient involvement with partner organisations including Discover Now, Prem, NHSe dialysis transport.

LKN patient oral and poster presentations at BTS and UKKW.

Key challenges

Gap in PPI leadership has led to delays in furthering patient engagement and involvement.

Patient representation to be achieved in remaining workstreams.

Wider patient representation remains limited – this needs to be progressed.

Key achievements

Health Equity Audit 2022 published. Half-day in-person workshop including patients and health care professionals discussed the findings. They agreed a set of 6 priority areas for improvement as a result.

Health Equity  “Improved” qualitative study established and partnerships made with local groups to support the study to be conducted with local communities groups.

Renal health inequalities knowledge audited amongst NHS staff leading the LKN HEG to create an HE e-module to support learning and understanding across all staff groups.

Health Equity Ambassador role created.   These voluntary role can be at taken up by anyone with an interested in health Equity, and aims to promote a culture of equity across services and more broadly across London.

Key challenges

Inconsistent engagement and participation with identified priorities to the current challenging healthcare situation.

Difficult identifying appropriate measurement tool to demonstrate impact of HEG  across renal units. 

Complexities in building relationships with ICB Population Health and Health Inequality leads due to the emerging nature of ICB posts.

This webinar provided an opportunity to: 

✔️ Understand the importance of identifying CKD early 

✔️ Learn how to identify and screen those at risk of CKD 

✔️ Identify key ways to manage CKD, including medications that protect the kidneys 

✔️ Understand the importance of coding CKD and how best to code CKD 

✔️ Hear practical experiences and insights from primary and secondary care

It covered

1. The Kidney Health Check in adults living with diabetes or hypertension:  how to identify CKD early
    
2.  ‘3 key interventions within 3 months to save lives’ for adults living with diabetes and kidney disease, or with proteinuric kidney disease
   
   
3. The new ‘CKD Coding in Primary Care Guidelines – LKN Expert Consensus’

4. The role of the nurse/pharmacist

This webinar provided an opportunity to: 

✔️ Hear an update on identification and management of chronic kidney disease with the advent of SGLT-2 inhibitors. 

✔️ Understand how to implement 3 key interventions in people with diabetic or proteinuric CKD to save lives.  

✔️ Explore the critical health inequalities context for chronic kidney disease risk and outcomes in London and Surrey Heartlands. 

✔️ Take part in an interactive session where experts from primary and secondary care will be available.

It covered

1. Identifying and optimising CKD management early in primary care through the launch of the LKN CKD Early Identification & Optimisation Pathways.
    
   
2. New approaches to reduce inequalities and save lives.

This webinar provided an opportunity to: 

✔️ Review findings of the LKN Health Equity Audit 2022.

✔️ Critically appraise findings in groups of experts, including patients, to agree the top 3 priority areas for each part of the patient pathway.

✔️ Agree the key themes and ways to address cross-cutting themes.

✔️ Agree the top 3 priorities to be led by the Health Equity Group.

✔️ Meet as a group, including acute hospital providers, GPs, primary care population health experts, and people with lived experience.

It covered

1. Sense checked data and assumptions.

2. Explored possible underlying causes of unwarranted variation.

3. Presented and discussed emerging priorities.

4. Agreed top health equity priorities for each LKN Workstream. 

5. Agreed overarching health equity priorities to be led by the Health Equity Group across London (Prevention and Early Identification, Practicalities for patients, Improving Patient Health Literacy).

This webinar provided an opportunity to: 

✔️ Explore why Green Nephrology is important and to plan what we can do to improve.  

✔️ Hear examples of national and local good practice. 

✔️ Begin to shape a plan to support us all to become greener as individuals, as Units, across ICSs and pan-LKN.

It covered

1. ‘Kidney Care in an overheating environment’ Environmental impact of treating kidney disease

2. ‘A National View of Green Nephrology’
   Initiatives to reduce environmental impact

3. ‘Examples of Green interventions’
   Best practice from Pharmacy, Dialysis technicians, Nephrologists

4. ‘The patient perspective’ Home dialysis with an environmentally friendly lens to improve patient experience

5. ‘Local examples of best practice’

This webinar provided an opportunity to: 

✔️ Update on AKI service provision in London.

✔️ Bring people together to reflect, learn and action plan.

✔️ Scope and share ideas about what’s working well, and where things could be improved.  

✔️ Seek agreement on what interventions might be needed and the timescales for doing so.

It covered

1. An Introduction to AKI in London

2. RSTP priorities and approach

3. London AKI Network (LAKIN)- history, achievements and future 

4. What does the AKI Data tell us?

5. Post-ITU perspective

6. Renal Unit feedback and priorities

This webinar provided an opportunity to: 

✔️Explore how the LKN creates value through its collaboration, now and in the future

✔️Develop and align around a set of LKN principles to guide LKN decision making and the behaviours of our members and partners

✔️Determine how we use and embed our principles into LKN ways of working

The workshop was held at the Royal College of Nursing and 19 people attended including, Nurse Leads, Operational and Clinical leads,  and Primary Care Leads.

It covered

1. Effective collaboration: working with others to create value together, in one of four or more ways.
• Shared voice
• Shared delivery
• aligned plans
• shared learning
2. Agreeing the priorities for the LKN: aligned plans and shared learning
3. The 8 characteristics of collaboration: agreed we should focus on ways to improve and measure, and ways to communicate and convene
4. Development of LKN Principles

This webinar provided an opportunity to: 

✔️ Explore how the LKN creates value through its collaboration, now and in the future.

✔️ Develop and align around a set of LKN principles to guide decision making and the behaviours of our members and partners.

✔️ Determine how we will use and embed our principles into LKN ways of working.

It covered

1. Network with colleagues, in-person.

2. Understand the value of a systematic approach to improving quality, and alignment to the LKN’s objectives.

3. Hear Matthew Syed’s interesting and diverse examples on how and why we should embrace the opportunity before us, using a growth mindset.

4. Discuss taking themes, challenges and inspirations back to our units to begin to develop plans to deliver improvements.