“ Our renal patients are often known to us for many years and finding new ways of collaborative working to improve the quality of care we deliver makes this role both exciting and a privilege.”

Jackie McNicholas, renal frailty clinical nurse specialist, Hammersmith Hospital

Our kidney and transplant service

3,500 patients

170 kidney transplants annually

9 dialysis units

£35 million spent annually on dialysis

was especially difficult for frail individuals. The virtual clinic allows renal specialists to see all GP notes and make a considered recommendation about the patient’s care within one to two weeks. If it is recommended that patients are still seen in person, the reviewing doctor books the patient into the most appropriate clinic.”


Since the introduction of the virtual model, face-to-face appointments are only required in approximately 30 per cent of referrals, meaning patients spend less time in hospital and get faster access to the right specialist care. It also frees up time and space for patients who do need hospital care.

Spring 2020

“We started this work about five years ago and a lot of people have worked hard to improve the delivery of renal specialist input,” James explains. “This meant implementing an educational programme for primary care colleagues, monitoring an email advice line for GPs with a 36-hour response time, developing new renal education nurse roles and visiting local practices to perform clinical reviews of patients. “As a group of nurses, dieticians, pharmacists and doctors, we have enjoyed getting out to practices and getting to know our GP colleagues, which undoubtedly helps clinical interactions. It has helped us understand the pressure faced by GPs and how best to talk to one another.” Dr Ian Goodman, a GP based in Northwood, praised the service: “From a GP’s perspective, the virtual renal clinic is a godsend. I am now able to refer a patient with a renal condition safe in the knowledge that I will get a response within a few days. For the patient, it means that many can have their condition managed without attending hospital, saving both the patient and the NHS valuable time.”


Launched for Hammersmith and Fulham in April 2019, the programme then extended in July to involve Central and West London CCGs. Currently, the virtual clinic is operating in four of the eight


To learn more about this programme, contact Dr James Tomlinson (

Trust/ 7

CCGs in North West London and referral numbers are growing. With plans to roll out to all eight, the virtual clinic will be under great pressure with current workforce.

“In order to build on our success so far, we’ll need to secure ongoing funding to support the service; from administration, specialist nurse input and consultant time,” James says. “It’s a challenge I’m confident can be overcome, considering the issues we’ve already resolved to get to where we are. The momentum is there.”

There are further challenges for the virtual clinic with its increasing usage. Technology will need to keep up with demand, but this should also present opportunities to further refine and streamline the service. Generating quicker and clearer recommendations to GPs and even developing educational materials for patients are just some of the ways in which the service hopes to continue to develop, but it has already taken vast steps to improving the care of patients and the efficiency of both hospital and GP services.


• Over four million people in the UK are expected to have CKD by 2036

• Renal replacement therapy (dialysis or transplant) accounts for two per cent of the annual NHS budget

• Acute kidney injury plays a role in up to 18 per cent of hospital admissions

• Diabetes and hypertension are the most common causes of CKD, affecting about 80 per cent of people on dialysis

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