GPs may offer dialysis to kidney patients under new framework
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《英国医生杂志》
Patients with kidney failure could be offered dialysis at their GP抯 surgery, so that one of the five key standards set out in the new national service framework for renal services can be met.
The first part of the framework, which was published last week, recommends flexible options for dialysis that are suited to patients?needs and lifestyle.
Around 30 000 patients in England have established renal failure, about half of whom have had a transplant and half are on dialysis. Dr Steve Smith, president of the British Renal Society, explained that the biggest challenge facing renal units is dealing with the growing demand for dialysis.
"We are looking at a doubling of the number of patients requiring dialysis over the next 10 years, and we simply can抰 train nephrologists fast enough to meet the demand. Patients are living longer on dialysis, and the number of new patients requiring treatment each year exceeds the number who drop out," he said.
Despite the growing number of patients with established renal failure, the proportion of patients on dialysis is lower in the United Kingdom than in many European countries, including Spain, Germany, Greece, and Italy.
Among the priorities set by the framework for 2006 is an expansion of dialysis capacity so that patients can be treated nearer home, and Dr Smith predicts that GPs and specialist nurses will play a key part. He is currently negotiating for five dialysis machines to be installed at a practice in Sutton Coldfield, West Midlands, where GPs have a special interest in and expertise in nephrology.
"We need a lot more small units around the country where relatively well patients can be treated in a relaxed environment, rather than having to travel to hospital units geared up to treating critically ill people," said Dr Smith.
Although welcoming the framework, the National Kidney Federation (NKF)梩he UK charity for kidney patients梙as expressed concerns about funding.
"We are disappointed that the NSF lacks 慹nforcement of the implementation?of these standards, and we note that the document also lacks targets and costings that would have enabled the NKF to hold both the government and service providers to account," Gordon Nicholas, the federation抯 chairman, said.
Other priorities for action by 2006 that are set out in the framework include:
A national survey to identify local priorities and compare progress,
National audit of all renal units to facilitate the spread of best practice, and
Implementation of National Institute for Clinical Excellence appraisals of home dialysis and immunosuppressive treatment.
A second part of the framework, on prevention and end of life care, is in development.
Part 1 of the national service framework for renal services, Dialysis and Transplantation, is accessible at www.doh.gov.uk/nsf/renal/index.htm(London Jenny Bryan)
The first part of the framework, which was published last week, recommends flexible options for dialysis that are suited to patients?needs and lifestyle.
Around 30 000 patients in England have established renal failure, about half of whom have had a transplant and half are on dialysis. Dr Steve Smith, president of the British Renal Society, explained that the biggest challenge facing renal units is dealing with the growing demand for dialysis.
"We are looking at a doubling of the number of patients requiring dialysis over the next 10 years, and we simply can抰 train nephrologists fast enough to meet the demand. Patients are living longer on dialysis, and the number of new patients requiring treatment each year exceeds the number who drop out," he said.
Despite the growing number of patients with established renal failure, the proportion of patients on dialysis is lower in the United Kingdom than in many European countries, including Spain, Germany, Greece, and Italy.
Among the priorities set by the framework for 2006 is an expansion of dialysis capacity so that patients can be treated nearer home, and Dr Smith predicts that GPs and specialist nurses will play a key part. He is currently negotiating for five dialysis machines to be installed at a practice in Sutton Coldfield, West Midlands, where GPs have a special interest in and expertise in nephrology.
"We need a lot more small units around the country where relatively well patients can be treated in a relaxed environment, rather than having to travel to hospital units geared up to treating critically ill people," said Dr Smith.
Although welcoming the framework, the National Kidney Federation (NKF)梩he UK charity for kidney patients梙as expressed concerns about funding.
"We are disappointed that the NSF lacks 慹nforcement of the implementation?of these standards, and we note that the document also lacks targets and costings that would have enabled the NKF to hold both the government and service providers to account," Gordon Nicholas, the federation抯 chairman, said.
Other priorities for action by 2006 that are set out in the framework include:
A national survey to identify local priorities and compare progress,
National audit of all renal units to facilitate the spread of best practice, and
Implementation of National Institute for Clinical Excellence appraisals of home dialysis and immunosuppressive treatment.
A second part of the framework, on prevention and end of life care, is in development.
Part 1 of the national service framework for renal services, Dialysis and Transplantation, is accessible at www.doh.gov.uk/nsf/renal/index.htm(London Jenny Bryan)