BMJ Qual Saf doi:10.1136/bmjqs-2011-000664
  • Quality improvement report

A collaborative project to improve identification and management of patients with chronic kidney disease in a primary care setting in Greater Manchester

  1. Janet Hegarty6
  1. 1NIHR CLAHRC for Greater Manchester, Salford, UK
  2. 2Manchester Business School, Manchester, UK
  3. 3NHS Bury, Manchester, UK
  4. 4NHS Bradford and Airedale, Bradford, UK
  5. 5Department of Health, London, UK
  6. 6Salford Royal NHS Foundation Trust, Salford, UK
  1. Correspondence to Dr Gill Harvey, Reader in Health Management, Manchester Business School, Harold Hankins Building, Booth Street West, Manchester M15 6PB, UK; gill.harvey{at}
  1. Contributors All authors contributed to the conception and design of the paper. JH and GH prepared the initial draft of the manuscript and coordinated the process of editing and revision. All authors were involved in the reviewing process and read and approved the final manuscript.

  • Accepted 27 March 2012
  • Published Online First 3 May 2012


Problem Research has demonstrated a knowledge and practice gap in the identification and management of chronic kidney disease (CKD). In 2009, published data showed that general practices in Greater Manchester had a low detection rate for CKD.

Design A 12-month improvement collaborative, supported by an evidence-informed implementation framework and financial incentives.

Setting 19 general practices from four primary care trusts within Greater Manchester.

Key measures for improvement Number of recorded patients with CKD on practice registers; percentage of patients on registers achieving nationally agreed blood pressure targets.

Strategies for change The collaborative commenced in September 2009 and involved three joint learning sessions, interspersed with practice level rapid improvement cycles, and supported by an implementation team from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Greater Manchester.

Effects of change At baseline, the 19 collaborative practices had 4185 patients on their CKD registers. At final data collection in September 2010, this figure had increased by 1324 to 5509. Blood pressure improved from 34% to 74% of patients on practice registers having a recorded blood pressure within recommended guidelines.

Lessons learnt Evidence-based improvement can be implemented in practice for chronic disease management. A collaborative approach has been successful in enabling teams to test and apply changes to identify patients and improve care. The model has proved to be more successful for some practices, suggesting a need to develop more context-sensitive approaches to implementation and actively manage the factors that influence the success of the collaborative.


  • Funding The project reported in the paper was undertaken within the NIHR CLAHRC for Greater Manchester, which is funded by the NIHR and the 10 primary care trusts in Greater Manchester.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Additional data available on request from the corresponding author.

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