GP and Clinical Senior Lectuer in Primary Care

I am a GP and Clinical Senior Lecturer at the Centre for Primary Care.

I am GP Clinical-Academic Lead for the NIHR CLAHRC Greater Manchester Kidney Health Programme

http://clahrc-gm.nihr.ac.uk/our-work/kidney-health/

I am a member of the Think Kidneys Programme Board. Between 2014 and 2017, I was Co-Chair of the NHS England Think Kidneys Programme Intervention Workstream.                                   

https://www.thinkkidneys.nhs.uk/

https://www.youtube.com/watch?v=R-vR5N7Vh3w

Aligning my leadership roles within NIHR CLAHRC Greater Manchester and the Think Kidneys Programme, from April 2017, I will be GP Lead for the RCGP Acute Kidney Injury Quality Improvement Project. This builds on my role as a member of the RCGP Kidney Care Clinical Priority Programme (2013-2016).

http://www.rcgp.org.uk/clinical-and-research/clinical-news/new-beginnings-2017-clinical-rcgp-projects.aspx

My vision is to embed the relevance of kidney health into the routine care delivery both in the context of improving cardiovascular health outcomes and in the context of improving patient safety.

Acute Kidney Injury                  

Recognising that Acute Kidney Injury (AKI) is a major marker of patient safety, my programme of research seeks to align local, regional and national initiatives to improve health outcomes through the prevention, detection, and management of AKI. The programme comprises the implementation and evaluation of AKI-related interventions in both primary and secondary care as well as across the interfaces of care. It embraces an approach that seeks to ensure the development of an evidence base that is grounded in an understanding of everyday clinical practice. Through the lens of acute kidney injury, the range of projects being undertaken aim to understand and a) maximise the clinical utility of health informatics in patient safety, b) optimise medication safety, c) ensure safer transitions of care, d) improve the effectiveness, safety and experience in care for vulnerable individuals who  have had an episodes of illness complicated by AKI. 

Prevention of AKI 

Think Kidneys Sick Days Guidance Statement:  

https://www.thinkkidneys.nhs.uk/aki/wp-content/uploads/sites/2/2015/07/Think-Kidneys-Sick-Day-Guidance-v8-131115.pdf

Qualitative Research: Evaluation of Salford CCG Sick Day Guidance project:

http://clahrc-gm.nihr.ac.uk/our-work/kidney-health/salford-sick-day-guidance

Systematic Review: The risks and benefits of patients temporarily discontinuing medications in the event of an intercurrent illness. https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-015-0135-y

Randomised Controlled Trial: Can a sick-day protocol improve outcomes in Chronic Kidney Disease. Collaboration with University of Maryland, Baltimore   

http://grantome.com/grant/NIH/R18-DK110955-01

Detection of AKI

NHS England, UK Renal Registry, Think Kidneys. Acute Kidney Injury Best Practice Guidance: Responding to AKI Warning Stage Test Results for Adults in Primary Care. Think Kidneys, 2016    

https://www.thinkkidneys.nhs.uk/aki/wp-content/uploads/sites/2/2016/10/RespondingtoAKI-Warning-Stage-Test-Results-for-Adults-in-Primary-Care.pdf                                                   

I led the development of NHS England’s Think Kidneys guidance to support the recognition and response to AKI in primary care. The guidance supports the implementation of Acute Kidney Injury Warning Stage Test Results, a major (Level 3) patient safety directive that came into effect within all NHS Acute Trusts and Foundation Trusts in March 2015. A key challenge has been to maximise the clinical utility of AKI alerts and minimise the potential for burden on health professionals in terms of unnecessary workload as well as treatment burden for patients. To help ensure the delivery of high quality care, the guidance was grounded in an understanding of everyday clinical practice. To achieve this, I led a) a primary care working group, b) a consensus process using RAND/UCLA methods, and c) meetings and workshops held in London, Bristol and the North East. The Think Kidneys publications and resources have been quality assured and published in NICE’s Local Practice Collection.                                                

https://www.nice.org.uk/sharedlearning/linking-nice-aki-quality-standards-with-think-kidneys-resources

Managing Acute Kidney Injury together for better health (MAKIT Better study)                

http://clahrc-gm.nihr.ac.uk/our-work/kidney-health/makit-better/                                         

Evaluation of AKI qualitative improvement initiatives being carried out in both Salford Royal and Central Manchester University Hospitals NHS Foundation Trusts. 

http://clahrc-gm.nihr.ac.uk/our-work/kidney-health/makit-better/

Management of AKI:                                                                      

Bury CCG Primary Care Management of AKI                        

https://www.thinkkidneys.nhs.uk/aki/wp-content/uploads/sites/2/2017/02/Bury-AKI-Think-Kidneys-Case-Study.pdf                                                                                             

Through collaboration with Bury Clinical Commissioning Group, all 31 general practices across the CCG are participating in this service improvement initiative, which comprises 1) an audit of AKI-related activity, 2) educational training sessions to over 100 health professionals, and 3) development of a practice-level action plan. The project is aligned with national and international guidance, with the aim to a) improve diagnostic coding of AKI in primary care, b) optimise medication reviews, c) ensure timely follow-up including assessment of kidney function, and d) improve communication with patients and carers about the importance of kidney health and AKI risk.

Other AKI Resources for Primary Care

Think Kidneys Publications                                                          

https://www.thinkkidneys.nhs.uk/aki/wp-content/uploads/sites/2/2016/02/Think-Kidneys-Resources-for-Primary-Care-Managing-Acute-Kidney-Injury-Warning-Stage-Test-Results-1-1.pdf  

BMJ e-Learning Module. Acute Kidney Injury: Diagnosis and management in primary care    

http://learning.bmj.com/learning/module-intro/acute-kidney-injury.html?moduleId=10057644&searchTerm=%E2%80%9Cacute%20kidney%20injury%E2%80%9D&page=1&locale=en_GB

Chronic Kidney Disease

I have led patient-centred research focused on making kidney health meaningful for patients, the public and health professionals. The research has sought to navigate the challenge of maximising the clinical utility of a CKD diagnosis whilst minimising the potential for treatment burden. Steps taken to achieve this include:                                                

NIHR CLAHRC Greater Manchester

Daker-White G, Rogers A, Kennedy A, Blakeman T, Blickem C, Chew-Graham C.  Non-disclosure of chronic kidney disease in primary care and the limits of instrumental rationality in chronic illness self-management. Social Science & Medicine 2015; 131: 31-39. https://www.ncbi.nlm.nih.gov/pubmed/25748112                           

Overall Winner of Royal College of General Practitioners Research Paper of the Year Award 2016

Blakeman T, Blickem C, Kennedy A, Reeves D, Bower P, Gaffney H, Gardner C, Lee V, Jariwala P, Dawson S, Mossabir R, Brooks H, Richardson G, Spackman E, Vassilev I, Chew-Graham C, Rogers A. Effect of information and telephone-guided access to community support for people with chronic kidney disease: Randomised controlled trial. PLoS ONE 2014; 9 (10): e10913             

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0109135

NIHR School for Primary Care Research

Simmonds R, Evans J, Feder G, Blakeman T, Lasserson D, Murray E, Bennert K, Locock L, Horwood J. Understanding tensions and identifying clinician agreement on improvements to early-stage chronic kidney disease monitoring in primary care: a qualitative study. BMJ Open 2016. http://bmjopen.bmj.com/content/bmjopen/6/3/e010337.full.pdf 

This NIHR SCPR study informed the development of a kidney health module on healthtalk.org    

http://www.healthtalk.org/peoples-experiences/long-term-conditions/kidney-health/topic                                                                                                                      

Aligned with my programme of research focused on patient safety and kidney health, I am interested in addressing the 'second translational gap' between clinical research and healthcare delivery. In particular, through multidisciplinary research I am interested in supporting the development of an evidence base that takes into account multimorbidity in the delivery of care for people living with long-term conditions. As a member of the Long-Term Conditions research theme at the Centre for Primary Care, my research considers the practise of minimally disruptive medicine in both research design and delivery of care.
 

I currently chief investigator for a randomised controlled trial evaluating a complex self-management intervention aimed at improving outcomes for patients with stage 3 chronic kidney disease. This study forms a key element of the Collaboration for Leadership in Applied Health Research (CLAHRC) for Greater Manchester, which aims to improve the quality of vascular care for people with vascular diseases.

Member of the Royal College of General Practitioners

Fellow ad eundum gradum, The Royal Australian College of General Practitioners

Member of Think Kidneys Programme Board 2014-

Member of RCGP Kidney Care Clinical Priority Programme 2013-2016

1993 Bachelor of Medicine, Bachelor of Surgery, University of Newcastle Upon Tyne.

1997 Diploma in Child Health, Royal College of Physicians & Surgeons, Glasgow.

1999 Certificate of Prescribed Experience, The Joint Committee on Postgraduate Training for General Practice, United Kingdom.

1999 Member of the Royal College of General Practitioners, United Kingdom. Pass with Distinction

2004 Masters in Health and Community Research, The University of Manchester.
Pass with Distinction

2010 PhD School of Medicine, The University of Manchester