NHS Regional Renal Networks

NHS England has established regional renal networks in recognition of the efficiencies that can be obtained from drawing on innovation and expertise. There has been considerable variation in their development over the year, but the benefits of collaboration are such that the NKF will support and encourage their ongoing effectiveness as they become established.

NKF requested the regional networks to update them on the work they have planned for home dialysis in 2023.

A major theme in the responses received has been the focus on reimbursement for utility bills, particularly in the light of the increases in energy costs that have occurred over the past year. In response to the NKF’s request for an update, the North East network had focussed on the standardisation of reimbursement costs across the region and provided a copy of their Position Statement.

Of those that have moved furthest in their development, a synopsis of their progress so far is as follows:

The London Kidney Network – Home dialysis is central to the London Kidney Network (LKN) approach to improving the care of those living with kidney disease and includes initiatives covering both Home Haemodialysis and Peritoneal Dialysis. The LKN Equity Audit 2022 showed inequities within the pathway, predominantly linked to treating centre, and will be working to address these in the coming year. There are two patient representatives on our Workstream, as well as a number of others who work on a more informal basis. Home reimbursement guidelines have been developed which the LKN renal units are rolling out locally, in line with the national guidelines published last year.

In Peritoneal Dialysis (PD) diverse clinical expertise and interest across London units, including people with lived experience, is being harnessed whilst building upon a rapid growth of people doing PD at home through the Covid-19 pandemic.

We are trying to improve experience and outcomes for people on dialysis by:

• Focusing on PD training.

• Ensuring we have the right workforce to support patients dialysing at home.

• Focus on improving the care of people with PDrelated peritonitis.

• Improving access to peritoneal dialysis.

In Home Haemodialysis (HHD) the network is in the early stages of bringing together people with an interest in HHD but this will be an important part of the approach for the forthcoming year. This collaboration will build upon the development and implementation of network-level guidelines around reimbursement of utility bills for people doing both haemodialysis and peritoneal dialysis at home.

The Midlands Kidney Network mirror their work streams on those of the Renal Services Transformation Programme and has work streams around AKI, CKD, Dialysis, Transplants and Systems Optimisation.

As part of the dialysis working group there is also a focus on home dialysis. As a network the Midlands currently has the highest number of patients across the region on home therapies compared to the rest of England. The national recommendation is that 20% of patients are on home therapies and as a network, we are over this figure. A key performance indicator for 25% of patients on home dialysis has been set by the region and work towards this is underway. Regionally there are 3 units that are not achieving the 20% target for home therapies at the moment, and work is ongoing to action plans to improve their rates.

In addition to this, there are high rates of peritonitis across the region, and there is a Quality Improvement project along with KQuIP to look at reducing this.

Another project under development as a pilot is looking at an Assisted Home HD programme, and work is in hand with three units across the region to pilot this service in their Trusts.

The North West Network was launched in November 2022. The dialysis workstream has set out an agenda for improvement in all spheres of practice and across all units in the North West. Overarching goals of the workstream are in alignment with RSTP and GIRFT recommendations with a focus on quality, safety, efficacy and cost effectiveness in care delivery to all recipients of dialysis therapies. For the year 2023-24, the three areas of focus for the next year will be: a Increasing home dialysis uptake. b Increase PD catheter insertion service and late start PD access. c High level and unit level process data acquisition from all units in the region.

We are pleased to note that all units have shown a great deal of enthusiasm for change in favour of improving their patient uptake of home dialysis therapies. Systematic quantitative (survey including workforce information/infrastructure/ other resources) and qualitative data (interviews) are being ascertained currently, to ensure that we can consider the interventions contextualised to the needs of individual units. All five units in the Northwest, have agreed on up to three interventions focused along the patient treatment journey – the advanced chronic kidney disease clinic, home dialysis training pathways and in-centre haemodialysis service. Units have different levels of maturity of pathways and learning from each other and implementing best practices will allow them to achieve positive results. We intend to ensure that robust QI methodology is embedded within these project plans. KQuIP is increasing its training outreach to larger numbers of participants from across all the teams in the North West. We anticipate that many of these projects will be well underway in the coming months with sustainability at the heart of all these changes.

The South East Network is engaged with KQuIP in establishing the DAYLife project which is underway in the region. The project so far has looked at establishing a baseline. Whilst the overall aim of reaching the minimum prevalence rate of 20% of patients dialysing at home continues, the actual rates have fluctuated over the past few months. This gives an opportunity to understand what is causing these variations, and where sites can focus on to improve them.

The South East Network is currently being formalised with workplans for each workstream being finalised. The dialysis workstream is due to commence officially in March.

The following are the aims of the home dialysis programme over the next 24 months:

• Ensuring all sites provide reimbursement to patients on home dialysis.

• Increase access to home HD/PD machines.

• Support a functional Assisted Automated Peritoneal Dialysis (AAPD) programme.

• Continuing clinical support – ensure patients receive regular clinical assessments, including home visits.

• Ensuring equity of access and removing unwarranted variation.

There are other elements of the network that will support this, such as setting up the dialysis workstream and minimising infection rates.