Our overall aims are:

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1. To minimise health inequalities by diagnosing and treating patients with chronic kidney disease appropriately across the patient population of Hanley, Bucknall and Bentilee and prevent their deterioration and thus need for dialysis or a kidney transplant in future.

2. To increase clinicians’ and other practice team members’ (e.g. health care assistants, clinical pharmacists and social prescribers) awareness of people who are at high risk of having CKD (e.g. those with diabetes, hypertension, heart failure, and/or who are obese) but have not been diagnosed; and boost their understanding of best practice in detection and clinical management.

3. To increase patients’ and carers’ awareness that they may be at high risk of having CKD, but have not been diagnosed; and what they should expect from their GP or practice nurse to screen for linked health conditions.

4. To boost the confidence, competence and capability of patients with CKD to utilise digital aids to self-care for their health condition(s), lifestyle and wellbeing better; and better adhere to their medication for their health conditions, thus preventing their deterioration, and in time, preventing kidney dialysis.

5. ​We hope to share our positive outcomes from this project from patient, clinician and local NHS management perspectives, by Autumn 2025.

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To view our guide on CKD please click here.