Is it feasible to provide haemodialysis within the primary care setting

T Hodnett

South Bristol Dialysis Unit, Knowle West Health Park

Problem: There is an ever-increasing number of patients requiring haemodialysis within the UK, both currently and more importantly the projected future growth. The problem is compounded by lack of resources to meet the future demand for haemodialysis. As a result there is a requirement to investigate alternatives so that we can meet the needs of haemodialysis patients in the future.

Purpose: A pilot investigation to be used to evaluate the feasibility of introducing haemodialysis into the existing/future premises of the primary care setting. The focus is on the financial feasibility and the appropriateness of providing haemodialysis within the primary care.

Design: Semi structured interviews to be utilised to discuss the thoughts of a variety of stakeholders, (e.g. GP’s, practice managers, consultant, business unit managers and operations managers). The responses analysed to determine the acceptability of the proposal and their initial perception of the feasibility of the concept. The interviews to be used to identify how care of the renal patient could be developed in the primary care setting, and whether role of the renal nurse could be developed.

Findings: The general findings were that the patient would benefit from the close proximity of the centre, and increased access to PCT services. In turn this would reduce the pressure of the referring nephrology services. The implication was that transport cost would be reduced, due to the close proximity of the centres. There were indications that pre dialysis nurse led clinics could run in conjunction with the dialysis sessions, and possibly PD and HHD clinics. The concept had greater potential for new primary care health centres. The other alternative is to investigate utilising space within cottage hospitals.

Conclusions: The feasibility is dependent on space and cost effectiveness of the nurse patient ratio. Potential solutions from the study implied that to be cost effective pre dialysis and diabetic care needed to be incorporated in to the role of the PCT renal nurse, as well as potentially care of the PD patient, providing an integrated care approach within the community.

Relevance: the concept is within the recommendation of the NKF for Renal and within the remit of the NHS Plan and the development of the Primary Care Trust. Transport remains a major issue for patients and it is presumed that reduced travel time and costs as most patients can get to their GP.

ADV 4109 R 23/11/04