This Transform Clinical Reference Group (CRG) supports patients with kidney failure. Each year, in England, approximately 5,500 people start treatment for kidney failure and there are currently around 43,000 people receiving treatment for kidney failure. Around 4 in 10 people are treated by circulating their blood through a machine which cleans it of toxins (haemodialysis). This can be done either in hospital or at home. About 1 in 10 people are treated using the thin membrane that lines the abdominal cavity (the peritoneum) as a filter. This is called peritoneal dialysis. Approximately half of these patients are treated by having a kidney transplant.
This clinical reference group covers:
- services for people with acute kidney injury
- the preparation for and delivery of dialysis, whether in a centre or at home
- people who undergo kidney transplantation.
- Chair: Professor Smeeta Sinha, National Clinical Director for Renal Services
- Lydia Ball, Lead Commissioner
- Catherine Croucher, Public Health Lead
- Nitin Kohle, Clinical member
- Arif Khwaja, Clinical member
- Rona Smith, Clinical member
- Lisa Wilcox, Clinical member
- Richard Baines , Clinical member
- Sharlene Greenwood, Clinical member
- Emma Vaux, Clinical member
- Helen Hurst, Clinical member (Nursing)
- Karen Jenkins, Clinical member (Nursing)
- Clare Morlidge, Pharmacy Lead
- Hayley Wells, Pharmacy Lead
- Ahmad Saleem Ullah, Renal Transformation Programme
- Albert Power, Renal Transformation Programme
- Nick Torpey, Renal Transformation Programme
- Rob Konstant, Hambling, Business Intelligence Lead
- Fiona Loud, Patient and public voice member
- Nichola Ibe, Patient and public voice member
- Maddy Warren, Patient and public voice member
- Clare Morlidge, Affiliate Member UK Kidney Association
- Richard Baines, Affiliate Member NHS Blood and Transplant
- Rommel Ravanan, Affiliate Member British Transplant Society
Guide to renal transplantation services
NHS England has produced a summary of renal transplantation services and how they are commissioned.
A key part of the CRG’s work is the delivery of the ‘products’ of commissioning. These are the tools used by the 10 Hub Commissioning Teams to contract services on an annual basis.
Service specifications are important in clearly defining the standards of care expected from organisations funded by NHS England to provide specialised care. The specifications have been developed by specialised clinicians, commissioners, expert patients and public health representatives to describe both core and developmental service standards. Core standards are those that all funded providers should be able to demonstrate, with developmental standards being those which may require further changes in practice over time to provide excellence in the field.
The following service specifications fall within the scope of this CRG:
- Acute kidney injury (adult)
- Adult kidney transplant service
- Atypical haemolytic uraemic syndrome (aHUS) (all ages)
- Centre haemodialysis ICHD
- Cystinosis diagnosis and co-ordination of management (all ages)
- Encapsulating peritoneal sclerosis treatment service (adults)
- Ex-vivo partial nephrectomy service (adults)
- Haemodialysis to treat established renal failure in the home
- Haemodialysis delivering only dialysis away from base (DAFB)
- Peritoneal dialysis to treat established renal failure
- Renal assessment (adult)
A commissioning policy is a document that defines access to a service for a particular group of patients. A NICE Technology Appraisal Guideline on the same topic will replace, or be incorporated into, a commissioning policy as appropriate. These are important documents that are developed to ensure consistency in access to treatments nationwide.
The following policies fall within the scope of this CRG:
- Eculizumab in the treatment of recurrence of C3 glomerulopathy post kidney transplant (all ages)
- Mercaptamine hydrochloride viscous eyedrops for corneal cystine deposits in people aged 2 years and over
- Rituximab for idiopathic membranous nephropathy
- Dialysis away from base policy
- Dialysis away from base frequently asked questions
Not routinely commissioned
- Eculizumab for the treatment of refractory antibody mediated rejection post kidney transplant
- Bortezomib for the treatment of refractory antibody mediated rejection post kidney transplant
Policy statements are brief documents that define the current commissioning position to support service contracting.
- Eculizumab in the prevention of recurrence of C3 glomerulopathy post kidney transplant
- Reimbursement of expenses for living donors
- Rituximab for the treatment of refractory focal segmental glomerulosclerosis in the native kidney in adults
Transport support for patients attending in-centre haemodialysis
In August 2021, NHS England and NHS Improvement published the outcome of a review into non-emergency patient transport services (NEPTS). This sets out a new national framework for a responsive, fair and sustainable service.
The updated eligibility criteria for the service includes a universal commitment of transport support for patients attending in-centre haemodialysis. This was developed following extensive engagement with key stakeholders, patient groups and commissioners.
The main principle of NEPTS is to travel independently with the support of family or friends if possible, or where appropriate receive financial reimbursement for travel costs. However, all patients registered with a GP in England who are receiving in-centre haemodialysis, should be offered transport support if required.
The local system should be flexible in providing transport support for all patients attending in-centre haemodialysis – whether or not they use NEPTS. Similarly, transport requirements should be part of dialysis away from base planning with referral to the NHS Who Pays? guidance.
Haemodialysis patients must be fully informed and involved in decisions about the right transport offer for them. This should be flexible to allow for changing requirements.
Dialysis units will play a key role in these conversations. Patients, relatives, clinicians and dialysis units can also seek support through engagement with renal networks and patient groups.
Further details can be found here: Transport support for patients attending in-centre haemodialysis.
Get in contact
For any questions or queries relating to the work of the internal medicine NPOC or any or its CRGs, please contact: email@example.com