Nephrology care in Lincolnshire is delivered by a collaboration between United Lincolnshire Hospitals and University Hospitals of Leicester.
Historically renal services for Lincolnshire patients were provided entirely by the University Hospitals of Leicester. A drive to deliver care closer to home has led to an increasing trend towards relative independence and more local provision for patients.
The service can be thought of as having several separate areas of provision although in reality these are closely linked and include:
- Haemodialysis
- Peritoneal dialysis
- Transplantation
- Renal community team
- General nephrology
- Inpatient nephrology services
- Acute kidney Injury
Haemodialysis
The service currently supports four outpatient haemodialysis units at Lincoln, Boston, Skegness and Grantham. The Boston, Skegness and Grantham units are private facilities at non-hospital sites where University Hospitals of Leicester commission treatment for NHS patients. These are managed by medical staff from the renal team at Lincoln County Hospital.
Lincoln County Hospital currently has 76 haemodialysis patients, Boston 72, Skegness 30 and Grantham 20 with an additional 15 patients undergoing haemodialysis in their own homes. In addition there is an inpatient area at Lincoln County Hospital which provides dialysis support for patients normally on haemodialysis within Lincolnshire who have medical problems (renal or otherwise) that require admission.
Haemodialysis clinics are conducted weekly at Lincoln (Monday) and Boston (first and third Wednesdays and second and fourth Thursdays). Skegness and Grantham are visited monthly by the respective consultant.
Peritoneal dialysis
Peritoneal dialysis catheters are inserted by the team at Leicester but ongoing management is provided locally by the renal community team supported by the renal consultants. There are approximately 45 peritoneal dialysis patients. Simple trouble shooting is also managed locally but more serious complications are dealt with at Leicester – this is likely to change as local services expand.
Peritoneal dialysis clinics take place at Lincoln (first and third Wednesday mornings) and Boston (fourth Wednesday afternoon).
Transplantation
All transplantation is done at Leicester, but once patients have been successfully transplanted for more than six month follow up is done locally. Transplant clinics take place weekly (Mondays), the consultants in charge are Dr Williams and Dr Hardy.
Renal community team
This has multiple roles including dialysis modality counselling, peritoneal dialysis training and management, home haemodialysis training and management and management of patients on a conservative pathway.
General nephrology
The majority of the general nephrology work is carried out in outpatients. General nephrology clinics take place at Lincoln (alternate Thursdays and every Friday). In addition there is a low clearance clinic at Lincoln on a Tuesday morning.
General nephrology clinics at Boston are all day Mondays and Wednesdays (with a low clearance clinic every Monday afternoon). The Wednesday clinic is held at the local Parkside Surgery complex. All day clinics take place at Grantham on the second and fourth Wednesdays.
Inpatient nephrology services/acute kidney injury
Patients with acute kidney injury and other nephrological problems are managed on Burton ward at Lincoln County Hospital. There is a senior doctor-led inpatient ward round to see renal inpatients and referrals each weekday and most weekends.
Acute haemodialysis is not undertaken at Lincoln at present other than on the intensive care unit, although this service development is planned in the future.