Demand for dermatology
It is estimated that 1 in 2 people in the UK each year, will suffer from some type of skin disease or condition. Skin cancer has the highest number of cases of any cancer in the UK. 20 per cent of children and 10 per cent of adults will suffer from eczema. There is a clear demand for services to meet this need, but for a health service that is currently facing unprecedented challenges both economic and structural, it is vitally important to find out how that need can best be met; in primary, secondary and tertiary settings.
At the British Association of Dermatologists’ Annual Conference in Birmingham this week (July 3rd to 5th) a number of presentations are being made which seek to address these questions.
At primary level General practitioners (GPs) are under considerable pressure to ensure that all referrals to specialist dermatology services are necessary. Commissioners of services are keen to manage demand for these services in order to get best value for money in a cash-limited National Health Service, a study in Hertfordshire sought to understand dermatology referrals and, using this information, identify ways to reduce referrals from an individual GP practice. The study, which took place over a six month period revealed that where referrals were made for long term skin conditions they tended to be highly appropriate, but those for skin lesions were less so, also that the average for a practice could be strongly skewed by a single high volume referrer. The study revealed that skin cancer referrals made up about two thirds of the total number, but that the accuracy and appropriateness of the referrals was low.
Julia Schofield, one of the authors of the study says “This study demonstrates the challenges for GPs in trying to reduce dermatology referrals. Most GPs see 42 patients per day, and with that level of activity, reducing referral rates from 2–3 per month is likely to be difficult, particularly across the breadth of dermatology conditions. However, we did see that in some cases a single GP might be referring far more than colleagues and that targeting education to high referrers within a practice is important, also some referrals might be reduced by improving GP skin lesion diagnostic skills and perhaps using digital images with referrals.”
A number of presentations were made on the need for local acute dermatology services, including on-call services.
A study by a team in Manchester looked at the usage of ‘urgency clinics’ (a three times a week clinic into which patients can be booked following urgent referral) and compared them with usage of general dermatology clinics. As anticipated the largest groups of patients in both clinics came from the two local PCTs, however the urgency clinics also saw a higher than proportionate number from 6 more distant PCTs which the team suspect to reflect the lack of acute dermatology clinic appointments in those areas, putting pressure onto central services and extending journey times for patients.
Sarah Felton, one of the authors of the study says ‘It is clear that when commissioning dermatology services within a community it is important to assess the need for acute dermatology services in order to be able to deal appropriately with urgent referrals as close to home as possible”.
Another study, this time in Leeds, focussed specifically on the on-call service. The hospital provides a 24 hour, seven days per week non-resident on-call service and not only provides a service to patients but also allows dermatology trainees the opportunity of gaining sufficient experience in emergency dermatological presentations to become competent in managing acute serious skin disease. Looking at the number and type of cases referred to the service over a two month period the data showed a significant demand for an out-of-hours service.
Sangeetha Shanmugam, one of the authors of the study says “Over 15 per cent of the cases we referred out of hours, and at least half required assessment on the day of referral, our data shows that there is a real need for this service providing essential specialist care for patients with a variety of serious skin diseases.”
Many people suffering with a chronic skin condition may not need urgent care, but do require specialist referral. A team in Dewsbury looked at whether specialist multi-professional clinics were necessary for patients with complex skin problems. The aim of the clinic was to provide a multi-professional review of patients with complex and rare skin conditions, especially where the diagnosis was in doubt or there were problems with management. Facing criticism that this one hour a month clinic was a ‘luxury’ the team sought to analyse it’s exact benefits. The most important benefit was shown to be that 95% of the patients seen could be offered a new diagnosis or treatment and that improved patient care would also have beneficial cost-implications.
Manu Shah, the author of the study says “A regular specialist multi-professional clinical meeting is a good use of clinician time and produces great benefits to patient care. In the economic climate, dermatologists must strive to maintain quality care for their patients, despite pressures from medical and non-medical managers.”
The study was released at the British Association of Dermatologists’ Annual Conference, 3rd to 5th July 2012
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Next review: 23 March 2020