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Clinical renal networks: evolving services and expertise around the UK
  1. P Houtman
  1. Children's Hospital, Leicester Royal Infirmary, Leicester, UK

Abstract

Aims To determine the range of renal services available outside major paediatric nephrology centres, and the clinical expertise operating to deliver this. To understand the functioning of clinical networks. Also, to compare with a similar survey from ten years ago.

Methods On behalf of the British Association for Paediatric Nephrology, initial information was received from all major paediatric nephrology centres about surrounding hospitals and possible “link” paediatricians. A further questionnaire was then sent to all paediatricians thus identified (n=111). This survey covered aspects of clinical practice and experience, governance, management and job-planning.

Results Fourteen paediatric nephrology centres in the UK interact with at least 202 other paediatric centres, providing services, help and advice in conjunction with local paediatricians. However, the way this is delivered varies considerably, ranging from actively managed networks, to ad-hoc interaction without planned direct contact. In over 125 local hospitals, there was a stable relationship between a single lead paediatrician and a named paediatric nephrology centre, and in 104 places, regular shared-care nephrology clinics were undertaken. The burden of shared care clinics around the UK amounted to a total of 538 clinics per year. In over 50 other hospitals (mainly smaller centres), there was no significant link. In 65 full replies from local paediatricians with “renal interest/expertise”, level of service and expertise varied widely. Of these, 49 paediatricians took renal referrals from their colleagues and 31 conducted regular nephrology-only clinics alone. Individual renal workload varied between <1 and 5 P.A.s per week, although usually not specifically defined as such in job-plans. The survey highlighted the impact of the follow-up of antenatally-detectable renal tract anomalies, and these services were often delivered independently from other renal provision. Compared to a similar survey from 10 years ago, there has been considerable expansion in local designated renal services.

Conclusion These data highlight the quantity and range of renal services delivered outside major paediatric nephrology centres in the UK, by paediatric nephrologists, and paediatricians with varying renal expertise, and provide important information for developing networks and appropriate workforce planning.

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