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A pioneering clinic at Ladywell Pharmacy is having a life-changing impact on patients with early-stage chronic kidney disease. Saša Janković spoke to the man behind the innovation to find out more…

Although he doesn’t work at Ladywell Pharmacy in South-East London, pharmacist Darshan Negandhi has a close connection with the business, and the community it serves.

Darshan is the proprietor of Lewisham Pharmacy, which he runs alongside his friend Sanjay Patel who owns Ladywell Pharmacy, and it was Sanjay who invited Darshan to act as the clinician “at the coalface” to design and clinically lead a pioneering multimorbidity point-of-care Healthy Kidney Clinic.

Built on a collaborative, pharmacist-to-pharmacist partnership, with Ladywell Pharmacy providing the setting and local integration, the clinic targets patients with proteinuric chronic kidney disease (CKD) – a group at increased risk of cardiovascular complications and renal decline.

Direct response to high CKD prevalence and multimorbidity

This is in direct response to high CKD prevalence and multimorbidity in Lewisham, especially among underserved groups, as well as data showing more than 60 per cent of proteinuric CKD patients were sub-optimally treated despite regular healthcare contacts.

“Working in Lewisham, I’m acutely aware of the impact of health inequalities and the high prevalence of hypertension and type 2 diabetes, both of which accelerate kidney damage”, explains Darshan.

“These are the patients who, on paper, look like they’re doing okay because they are in the early stage of the disease, but actually they’re quietly progressing and heading towards real problems if nothing changes.”

He says many of these patients sit in a grey area between primary and secondary care, where they are not yet unwell enough to be referred to nephrology, but still require active intervention. “CKD can be mind-blowing,” he says.

“People think ‘that’s one for the hospital’ but there can be long waiting lists, and while patients are waiting, their kidneys are continuously declining.

“By intervening earlier to slow that decline, and fine-tuning therapies at the right time, we can reduce the progressive nature of kidney disease and help people stay healthier at home, rather than waiting until they reach end-stage renal failure and need dialysis.”

Pharmacy-led intervention

EMIS-driven searches and CESEL optimisation tools enabled Darshan to identify 97 eligible patients and design a pharmacy-led intervention to proactively deliver guideline-led care with the convenience and accessibility of the community setting.

During a pilot in May and June of 2025, 27 patients were reviewed in a six-week period and 100 per cent received structured CKD education and medication reviews while 80 per cent were newly started or optimised on disease-modifying agents.

“Using capillary blood testing, I could check eGFR, serum creatinine and potassium on the spot,” Darshan explains. “That meant I could safely escalate treatment there and then, rather than sending people away to wait for blood tests and another appointment.”

As an independent prescriber, this also allowed Darshan to optimise medicines in line with guidelines, including titrating ACE inhibitors or ARBs, optimising statin therapy and initiating SGLT2 inhibitors where appropriate.

“It wasn’t a one-off appointment,” he adds. “Most patients needed at least two touchpoints, sometimes more, to make sure changes were safe, effective and properly embedded.”

Crucially, he says the care was designed around accessibility. “People were being seen quickly, in longer appointments, at times that suited them, including evenings and weekends. Some of these patients hadn’t been able to get a GP appointment, let alone see a specialist.

“This was about bringing high-quality, guideline-led care to where people already are, and stopping kidney disease from progressing while patients are stuck waiting.”

Positive patient response

Darshan says the patient response to the service was overwhelmingly positive, particularly because many people had not previously understood their condition or realised that anything could be done at such an early stage.

“A lot of people said to me, ‘I didn’t know this, thank you for telling me,’” he says. “They finally understood why they’d been invited and what was actually happening with their kidneys.”

Being seen promptly, in a familiar and accessible setting, also made a significant difference to patients’ day-to-day lives. “People didn’t have to take time off work, sit on a waiting list or travel to hospital,” he says.

“They were coming into their local pharmacy at times that suited them, and having proper, meaningful consultations.” In addition, patients felt reassured by the proactive nature of the service.

“There’s a huge amount of anxiety when you’re told something is wrong with an organ like your kidneys,” says Darshan. “What this clinic did was take away that fear of the unknown. Patients left knowing there was a plan, that something was being done, and that someone was keeping an eye on them.”

He believes this reassurance has a lasting impact. “When people understand their condition and feel supported, they engage more with their treatment and with their health overall,” he says.

“That confidence and peace of mind is just as important as the medicines, because it helps people get on with their lives, rather than worrying about what might happen next.”

System expertise

Indeed, Darshan is clear that the service only worked because it was built around strong teamwork and genuine multidisciplinary collaboration.

“The clinic was never about a single professional working in isolation, but about bringing together the right expertise across the system and using it in the right place”, he says.

“This was very much a multi-agency, multi-faceted approach. We were working alongside renal clinicians at King’s College Hospital with remote specialist input when needed, the Health Innovation Network as the enabler, the ICP providing the authorisations and governance, and the PCN identifying the patient population. That is what neighbourhood working really looks like.”

Darshan says the success of the pilot has opened up wider conversations about how the model could be expanded and adapted.

“If we can do this in something as complicated as kidney disease, then we can absolutely do it in other areas such as asthma and COPD.

“It’s about pharmacy being seen as a trusted clinical partner that can take on structured, preventative services which reduce pressure on general practice and hospitals and keep patients healthier at home.”