Minutes of the Renal Association

Minutes of the Renal Association

Minutes of the Renal Association

Clinical Affairs Board

Wednesday 19th March 2008, 4.00 pm

Library Annexe, The Novartis Foundation, London

Present:

Kevin Harris (Chair)Donal O’Donohue

Charlie TomsonRobert Mactier

Martin RafteryPhil Kalra

Andy Lewington

  1. Apologies

Lawrence GoldbergJonathan Kwan

  1. Minutes of last meeting – (Paper A)

Agreed as a true record

  1. Matters Arising
  1. MR to contact Colchester, to explore the specific issues, they have in making returns to RR – no update
  2. CT to produce a simple guide to the required RR fields on co-morbidities. To be circulated to all CDs – work in progress
  3. Data managers and clinical directors, to be provided with performance data on their units completeness of returns – work in progress
  1. CAB report to the Executive February 2008 (Paper B)

Noted

  1. Renal Registry:

a)Verbal update from Chair

Improving the completeness of the returns to the Renal Registry remained an ongoing issue. In addition to the plan to provide CDs and data managers with performance reports, this would also be sent to commissioners.

Vascular access audit was a new data item. A pilot involving seven sites had been initiated with data collection on peritoneal and vascular access. Vascular access survey will be undertaken in “partnership” with the Information Centre, with funding from the Health Care Commission. There were some ongoing contractual issues. It was hoped that these could be resolved but, if necessary CT would enlist the help of DO’D to resolve.

The RR report had been published three months earlier than in previous years. There were no paediatric chapters, because of ongoing problems related to electronic capture of data within paediatric units. Mark Taylor (chair BAPN) was optimistic these would be resolved, recognizing the complex governance arrangements that were required. RA to offer support to help resolve this issue if required.

b)Displaying RR data on the RA website and “NHS choices” website

The display of RR data on the RA website was approved

New data items for display would be proposed by the RR and agreed by the CAB. Alternatively, new data items might be proposed by the CAB after feedback from the CSC.

There had been no further contact from NHS Choices. Action: CT to chase

  1. Clinical Guidelines Committee:

a)Verbal update from Chair

AKI and transplantation guidelines still in draft. Action: RM to resolve.

A discussion took place about the process by which guidelines came to be signed off. It was agreed to continue with the protocol proposed by the previous clinical vice president but to ensure specific time limits were adhered to for responses. The chair of the RR was to have a specific responsibility for commenting on the audit measures. It was the responsibility of authors to take account of the comments made on the guidelines following posting of the draft. The CAB had a responsibility to reassure themselves that the comments had been appropriately listened to before they signed them off. A template for creating guidelines would be created by RM along with some clear advice about what constituted an audit measure.

The frequency of guideline updates should be every two to three years.

The guideline writing workplan and proposed authors were noted and agreed.

The joint RA / BAUS investigation of haematuria guidelines were noted and supported. It was felt that this guideline should be put on the RA website (subject to agreement with BAUS over publication).

b)ESA use and MHRA guidelines(Paper C and D)

MHRA response was noted. They had acknowledged that discontinuing ESAs was inappropriate, once target haemoglobin achieved. However, the remainder of the guidance was unchanged. It was felt there was little to be gained by pursuing this matter further.

c)Funding for Guidelines

The proposal to upgrade the presentation of the guidelines was discussed. There was no clear source of funding for this at this point, and the benefits of seeking funding for this were not apparent. It was agreed this would not be pursued at this point.

d)Renal Disease in Pregnancy Study Group - consensus statements – Rob MacTier(paper E)

The renal disease in pregnancy study group recommendations were discussed. Some reservations were discussed about the recommendations, and it was felt that it would not be possible for the RA to endorse these without consultation from members. However, it was agreed that it would be useful for the RA to have a guideline for the management of pregnancy in patients with CKD. Action: RM to take forward.

e)Conflict of Interest Statements for Co-authors

  1. Clinical Services Committee:

a)Verbal update from Chair

The next meeting would be at lunchtime at the RA meeting in May 2008.

A representative from Yorkshire still needs to be found.

The recent CD forum had been extremely well attended with positive feedback.

b)CD forum 2009

The general consensus was that London remained the best venue and that the Governor's Hall, St Thomas's Hospital was a suitable venue offering good value. Action: MR to arrange CD forum at the Governors Hall, St Thomas's Hospital. Suggested topics should be forwarded to MR.

c)NICE CKD guideline consultation

The CDs would be asked to forward their comments to MR who would collate them and pass on to the President. The President would respond to NICE on behalf of the RA.

d)Research in commercial HD units

CDs had been alerted to the importance of considering research, when agreeing commercial tenders for haemodialysis units.

e)Specialised services definition set

There were ongoing discussions with Bob Couch. Hugh Cairns was pursuing appropriate HRG definitions.

  1. Current National Issues:

a)Verbal update from National CD

There was a proposal to create a National Diabetes and Kidney Support Team. The structure and function was under discussion, with a proposal for a central knowledge management function and a presence in each SHA. Bev Matthews was to lead this development for the kidney community for six months. Potential work streams included: increasing patient and public involvement, improving primary care management of CKD, in proving care within kidney units, increasing transplant listing, advising on appropriate arrangements for specialist commissioning networks.

The National Screening Committee was examining the potential role of including screening for CKD as part of a proposed screening for vascular risk

An “End of Life” consensus workshop was being held in April and would lead to the generation of action plan to realise the vision.

b)18 Week Pathway

The clock stops and starts were being defined

c)HD capacity

Ongoing work about appropriate modelling for HD capacity was required. There was now a national acceptance of the need for HD capacity to increase year on year. This was felt to be a useful and positive commitment from the DH.

d)PbR

The work streams for PbR for RRT were nearing completion and would help inform more accurate indicated tariff and in due course the tariff for RRT. Further work needed to be done on “the year before dialysis” and end of life pathways.

e)Darzi

The need to continue engagement of the kidney community with this process was noted.

f)Draft renal failure symptom control guidelines

The appropriate changes had been made. It was agreed the RA would endorse this document and that it would be circulated to CDs by MR.

  1. Other issues for consideration

a)Draft Report from PD working party (Paper F)

Not formally discussed, but CAB members encouraged to feed any responses directly to MW.

b)Changing face of Renal Medicine (Paper G)

Not formally discussed. Action: PK asked to consider the report, and provide CAB with recommendations on any further action that may be required.

  1. Any other business

None

  1. Date and Venue for next CAB meeting

2nd July 2008

Norvartis Foundation, London

1:00 pm start

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