Archived Content Notice
You are currently accessing the Think Kidneys website. Please be aware that this site is an archive and contains content from the Think Kidneys project, which concluded in 2019. As a result, the information presented here is no longer being updated or maintained.
For the most current and relevant information, we encourage medical professionals to visit the UK Kidney Association for comprehensive resources and updates in the field. Patients and their families can find valuable, patient-centric information and support at Kidney Care UK.
We would also like to inform you that the Kidney Quality Improvement Partnership (KQIP) is now part of the UK Kidney Association. For more information, please visit KQIP’s homepage under the UK Kidney Association.
We thank you for your understanding and invite you to explore these recommended resources for up-to-date insights and guidance in kidney care and health.
The following is a recommended intervention identified by the TP-CKD programme for implementation with both staff and patients, to test the following question:
Can the use of intervention tools help to improve the knowledge, skills and confidence of patients with kidney disease to enable fuller participation in the management of their own health?
To explore other interventions identified by the programme, visit our Interventions Toolkit Home Page
Care Plans
Personalised care-planning is an essential component of effective supported self-management. People need to be supported to express their own needs and decide on their own priorities through a process of information-sharing, shared decision-making, goal-setting and action-planning. The emphasis on care-planning should be on proactive interventions to keep people as healthy as possible. The Department of Health have mandated that all people with a long-term condition have a ‘care-plan’ by 2020 (NHS 5 Year Forward View).
Care plans have been in existence for many years and there are many good examples. In general though it seems that, as currently practised, they are often complex documents, difficult to implement and not always reflective of a shared approach to decision making. Care plans should reflect mutually agreed goals and actions, by patient and health professional, and be updated regularly. Such plans can support partnership working and increase patient self-efficacy behaviours.
In its most basic form the care plan could be part of a letter addressed to the patient and copied to their GP (see Changes to Practice) which paraphrases the conversation which took place during a consultation and sets out the agreed goals and actions. This would also be available on PatientView. We recommend this simplified approach.
Useful Links and Resources
Click here to view a template ‘Letter to Patient’, designed by Kings College Hospital Renal Unit (Cohort 1)
The Kings Fund: Delivering better services for people with long term conditions.