Commissioning Hub
This page provides useful tools and documents when commissioning dermatology services.
Comissioning Checklist
Please see below link to the Commissioning Checklist which includes links to guidance and resources that commissioners can use.
Service Specifications
Community Level services
Intermediate led services (GPwER level or consultant led services)
Commisioned as local services only with no choices for patients
18 week wait services with patients seen within 4-8 weeks
Acute Level services
Secondary care dermatology services
18 week wait services providing choice to patients of hospital provider
Faster Diagnosis Services (no choice for patient, direct care to hospital cancer unit/centre)
Paediatric Dermatology
Working Party Report on Minimum Standards for Paediatric Services
Specialised Level services
Patients requiring specialised skin cancer diagnosis and treatment will either be managed by their local SSMDT or may be referred onto another SSMDT in another area for the specialist care, e.g. MOHS surgery. There is often a choice for patients on the surgical treatment pathway but not on the diagnosis pathway. Patients may be referred to another MDT for treatment (e.g. Head and Neck) or more specialised care not provided within their locality/region.
Psychodermatology (specialised services)
Cases in psychodermatology are often complex. Acknowledging the nationwide lack of psychodermatology resources, Psychodermatology UK have organised a monthly psychodermatology MDT for clinicians to discuss cases and obtain advice for a panel of experts. If you would like to discuss a case please contact Dr Alia Ahmed by clicking here.
Lessons Learnt
One of the key failures in procurement is when commissioners do not check whether the provider has qualified staff ready to go for the contract. It is essential that this is checked before the awarding of any contract for both sustainability and to ensure patients to not come to harm over the period of the contract. Given the shortage of consultants and nursing staff in dermatology it is essential that this is checked to ensure there is no disruption to local services and healthcare for patients.
It is necessary to understand activity to designing services around patient needs by doing a postcode analysis. Teledermatology should also be embedded in the contract across the pathway of care being provided by any provider in line with NHSE guidelines.
Advice and Guidance figures should be identified as part of any activity review. The BAD collects this data.
ICS’ can contact us directly for any Outpatient, Advice and Guidance and Skin Cancer Pathology data by Trust in their locality on serviceimprovement@bad.org.uk
Isotretinoin Prescribing
Isotretinoin prescribing requires a named Lead Prescriber for isotretinoin and Second Approved Named HCP (healthcare professional) for the service. An MDT should be in place where a Second Approved Named HCP is not accessible. A named dermatologist or pharmacist will give out the patient reminder card.
Defined referral pathway and action is taken by the provider if patients are identified with mental health or sexual function problems.
BAD ‘Acne referral guidance for primary care’ and BAD ‘Acne referral proforma’ (either as they are or adapted for local systems). The referral proforma documents the GP’s consent to be the second approved named HCP for patients under 18 years old.
GPwER services prescribing isotretinoin must have an agreement with a consultant dermatologist but are no longer supervised directly.
BAD Isotretinoin Patient Guide
Medicines for Children ‘Oral isotretinoin guide for young people’
Hard copies of risk minimisation materials (AoR form, patient reminder card, pharmacist checklist) will need to be delivered from Market Authorisation Holders to the provider (unless using electronic only) viaoralisotretinoinppp@linney.com or call: 0370 703 0602. Electronic copies are available at: www.medicines.org.uk/emc
