Implementing Finerenone across the Primary–Secondary Care Interface

Finerenone was introduced in NHS Grampian for patients with chronic kidney disease associated with type 2 diabetes. The agreed model was specialist initiation within secondary care, with transfer to general practice for ongoing prescribing and monitoring. 

The medicine had progressed through established governance routes, including the Formulary Group and Medicines Guidelines and Policies Group (MGPG), with primary care representation in these processes. 

When the pathway came to the Clinical Interface Group (CIG), it became clear that, despite formal approval, there was uncertainty about how it would work in day-to-day general practice. Key concerns included:

• Whether monitoring requirements would create additional workload for general practice
• How prescribing and monitoring responsibilities would transfer safely between care settings
• Whether expectations were fully understood and consistent across the system 

This created a risk that patient access to treatment could be delayed because of a lack of operational clarity, rather than any clinical disagreement.

The Clinical Interface Group provided a forum to bring together primary care, renal and medicines management colleagues to work through these issues in a practical way. Through this collaborative approach, the group:

• Reviewed the governance pathway and clarified decision-making roles across the system
• Worked with clinical leads to co-design a clear and workable prescribing and monitoring pathway
• Ensured monitoring aligned with existing chronic kidney disease (CKD) care, avoiding additional or duplicative workload for general practice
• Produced a short GP briefing to support consistent understanding and application across practices

In practice, some of these points required a few iterations to get right, but working through them together helped build confidence across the system.

The Associate Director of Pharmacy is a regular attendee at the CIG, helping to ensure that new medicines and prescribing changes are identified early and considered for potential interface impact. 

Finerenone offers additional protection for people with diabetic kidney disease by helping to slow progression of kidney disease and reduce cardiovascular risk.

Through interface working, this translated into:

• Timely access to treatment, without delay caused by system uncertainty
• Proportionate and safe monitoring, aligned to existing CKD review schedules rather than creating additional appointments
• A clear and consistent pathway, reducing variation in care across general practice 

This helped ensure that patients could benefit from treatment without unnecessary burden or inconsistency. 

Outcome

• A single, agreed pathway was established and supported across Interface Group, Formulary Group and MGPG
• Roles and responsibilities between primary and secondary care were clearly defined
• The pathway moved from approval into practical implementation in general practice

Key Learning

• Governance approval alone is not enough — interface working is essential to translate policy into practice
• Alignment with existing general practice workload and monitoring frameworks supports adoption
• Regular pharmacy input strengthens system awareness of medicines with interface implications
• Simple, practical outputs such as GP briefings help ensure consistent delivery at practice level 

For more information on this case study, please contact scotland.interface@rcgp.org.uk