Improving chronic kidney disease care in North East London: causal and implementation evaluation of specialist-primary care multidisciplinary teams

Chronic kidney disease (CKD) affects the kidneys' ability to filter blood and increases the risks of heart disease, hospital admission and kidney failure. It is often unrecognised or undertreated, and its burden is particularly high in North East London's ethnically diverse and socioeconomically disadvantaged communities. Renal specialists have therefore delivered multidisciplinary team (MDT) meetings within GP practices and primary care networks across North East London. The meetings review local CKD performance, discuss patients and agree actions, but their effectiveness, equity and mechanisms are unknown.

This PhD will determine whether, for whom, how and under what conditions these MDTs improve five routinely collected key performance indicators of CKD care. The student will combine a natural-experiment analysis of practice-level longitudinal data with interviews, focus groups and co-design. They will learn causal inference, interrupted time-series and staggered-adoption methods, multilevel modelling, qualitative implementation research, mixed-methods integration, patient and public involvement, reproducible analysis and research communication.
The overarching aim is to establish how specialist-primary care MDTs can produce sustained and equitable improvements in CKD care and to translate the findings into a scalable delivery and evaluation toolkit.

Year 1: complete the evidence review; co-produce a programme theory; audit data quality; secure approvals; and publish a protocol and analysis plan. Year 2: estimate overall, dynamic and dose-response effects, with robustness analyses. Year 3: assess variation by practice and population characteristics; conduct approximately 25-35 stakeholder interviews/focus groups; and integrate quantitative and qualitative findings. Year 4: co-design and test the acceptability of an equity-focused MDT toolkit, complete publications and the thesis, and support adoption across North East London and wider region.