Pilot Report: Executive Summary

The National CKD Audit (NCKDA) is commissioned by the Health Quality Improvement Partnership[1] (HQIP), as part of the National Clinical Audit Programme (NCA), and delivered by BMJ Informatica in collaboration with London School of Hygiene and Tropical Medicine, University College London and Queen Mary University

This is the first Audit Report and covers the pilot stage of the project that ran for 6 months from June to December 2014. 

Chronic Kidney Disease (CKD) is a long‐term condition, usually without any symptoms, where the kidneys do not work normally.    It is best identified by the regular testing of patients known to be at high risk of developing kidney damage due to the presence of other conditions such as diabetes or high blood pressure.  By identifying patients with CKD, general practitioners (GPs) are in a position to work with patients to reduce the potential complications of the condition.  These include premature cardiovascular disease, e.g. strokes or heart attacks; episodes of acute kidney injury and long‐term progressive loss of kidney function.  In addition, identifying this group of patients will help doctors prescribe appropriate medications.  

The NCKDA will run between April 2015 to December 2016.  It aims to identify the performance of General Practice, and the variation between practices, against the clinical standards set out in National Institute for Health and Care Excellence guidance, and to support best practice by the provision of computerised quality improvement tools.  These will provide GPs with the real time feedback on practice performance as well as identify specific patients who may need attention.   Furthermore, through the NCKDA website, the project will provide a source of educational material on CKD and disseminate a communications programme to raise awareness of CKD among those in primary care.  A final report on the NCKDA will be issued December 2016.

  • The pilot phase described in this report outlines the achievement of three early aims of the project:
  • Assessing the practicalities of recruiting practices and undertaking software installation.
  • Testing  data extraction from GP computer systems and the approach to data analysis
  • Development of an electronic quality improvement tool.

A subset of 440 Practices that had BMJ Informatica software solutions installed were approached for participation in the pilot phase, of which 161 agreed to participate by the end of December 2015.   The pilot data extraction for this report was done in early December 2015 for 94 practices.  Despite some of the challenges described in this report, for example handling historical laboratory data going back several years, subsequent analyses have provided a number of interesting initial findings.   It is reassuring to see that most practices test a high proportion of patients at risk of CKD specifically those with diabetes and hypertension.  However, consistent with previous studies, these pilot data suggest that CKD coding is variable in practices, and on average only half of patients with CKD identifiable on blood tests are being appropriately coded.  

Given the advantages of accurate identification of those with CKD, coding will be the initial focus of the quality improvement programme and the electronic quality improvement tool which has now been deployed on participating practice computer systems has been specifically designed to help GPs accurately code their patients.

Download the full pilot report (pdf)

[1] HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP holds the contract to manage and develop the NCA Programme, comprising more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual audits, also funded by the Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel Islands.   The NCKDA is funded by NHS England and the Welsh Government.