The Wessex Kidney Centre (WKC)
The Wessex Kidney Centre (WKC) is centred in recently commissioned premises at Queen Alexandra Hospital. The WKC provides a comprehensive renal service to an adult population of approximately 2.2 million, covering the majority of Hampshire, the Isle of Wight and the adjacent parts of Wiltshire, West Sussex, Berkshire and Surrey.
Dr Tim Leach (Chief of Service Renal & Transplantation Clinical Service Centre and Clinical Director Nephrology)
Mr Paul Gibbs (Clinical Director Transplantation)
Una Brady (General Manager)
Sheila Humphrey (Head of Nursing Renal & Transplantation)
Hazel Hartnett (Modern Matron)
Katie Beel (Business Manager)
Configuration of Clinical Services
WKC manages patients with all nephrological illnesses including acute, chronic, and end stage renal failure in patients of age 16 years upwards. All modalities of Renal Replacement Therapy (RRT) are available – haemodialysis (HD), haemodiafiltration (HDF), peritoneal dialysis (PD), automated peritoneal dialysis (APD) and Renal Transplantation. A comprehensive range of investigative procedures for all renal diseases is provided. The transplantation service provides an organ retrieval service, which has strong links with intensive care units and multi-organ transplant centres nation-wide.
Out-patient nephrology clinics (including general nephrology, haemodialysis, CAPD and transplant/vascular access review) run on every day of the week. In addition, the Consultant Nephrologists are responsible for peripheral clinics in the hospitals as outlined above
There are three dedicated Inpatient wards. The current bed complement is 45-49, with an additional 6 day-treatment beds. There is an out-patient dialysis ward with 25 stations, a Community PD unit and home HD team. The WKC has its own integral out-patient department and the facility to see programme patients as emergencies during the day. The majority of nursing staff on the Wards are nephrology trained and there is a locally run Nephrology Nursing Course. The Unit employs 2 wte Living Donor Transplant Co-ordinators, 3 wte Recipient Transplant Coordinators, 4 wte Renal Dietitians, a full-time Renal Pharmacist and a Transplant Immunosuppression Service team. There are excellent, committed nurse specialists in vascular access, transplantation, pre-dialysis care, home haemodialysis, peritoneal dialysis and anaemia management, who actively participate in and lead multidisciplinary team meetings, nurse-led and -supported clinics, audit and research.
The WKC has eight satellite dialysis units: Three are NHS owned/rented and staffed; Bognor Regis (14 stations), Totton in Southampton (9) and the Isle of Wight (10). The remainder are privately run and subcontracted: Basingstoke (16) and Chandlers Ford, Southampton (18) with Fresenius; Havant, Portsmouth (22), Salisbury (10) and Milford-on-Sea, New Forest (7) with Renal Services.
The current five-year development plan with commissioning partners delivered full outpatient haemodialysis capacity in 2013. Further expansion is being planned with the Trust and external consultation. The consultant team is responsible for satellites units, individually or shared, and holds regular dialysis clinics within the units. Peritoneal dialysis, home haemodialysis and transplant patients beyond the first three months are all seen as close to home as possible. At least 60% of outpatient activity occurs away from the Portsmouth hub.
WKC provides home haemodialysis with a dedicated training area and support staff. This is a recent development with the aim to continue to provide home HD to all patients who are eligible. The nXstage machine marketed by Kimal is currently being used as this minimises home conversion while still providing effective dialysis and being relatively portable. The current post-holder is the clinical lead for haemodialysis and home haemodialysis – experience in home dialysis, particularly with the nXstage machine, would be an advantage.
The Peritoneal Dialysis Team is nationally and internationally known for acute start PD, medical PD catheter insertion, nurse-led education and training and conscious sedation protocols. This post holder would be expected to participate in the insertion of double-cuff tunnelled Tenchoff peritoneal dialysis catheters and the training and supervision of the nephrology juniors in this technique.
The service also hosts and runs a Tertiary Hypertension service, with investigation, diagnosis, monitoring and management of simple and complex hypertensives. The Trust is considering renal denervation in addition.
The service provides acute and chronic transplantation services for the region, including all work up, surgical, nephrological and nursing care, dedicated anaesthetic staff, transplant coordinators (living donor, recipient and post-transplant), surgery and immediate, middle- and longer-term post-transplant management for donors and recipients. Hand-assisted laparoscopic nephrectomy is the donor operation of choice. There are a good number of local DCD donations and a dynamic and increasing living donor programme, with one of the highest number of non-directed altruistic donations in the country. The local commissioners favour transplantation, particularly pre-emptive. The H&I laboratory is off-site but provides an excellent cross-match service. Virtual cross-matching reduces cold-ischaemic time. ABO-incompatible transplantation is provided and HLA-incompatible transplantation is being considered for the near future. Extensive experience of acute transplantation, preferably with ABOi and/or HLAi transplantation, is vital for this post – currently four nephrologists provide the immediate peri- and post-transplant care with the transplant surgeons and specialist nursing team but all nephrologists work up patients for transplant, are involved in the management of acute transplantation out of hours and receive patients back from the acute service at three months post-op for ongoing post-transplant care, and there will be scope for an increase or rearrangement of the acute transplant team in the future.
The four transplant surgeons also provide a dedicated vascular access service, with good links to vascular imaging and interventional radiology, and excellent primary and secondary patency rates. This is evidenced by more than 80% of the service’s patients dialysing via a native fistula or graft, with the expectation of exceeding 85%. The vascular access nurse specialist provides and coordinates fistula and graft monitoring with pre-emptive investigation and treatment, further maintaining good access quality.