COVID 19 Recovery of Services
Operational Planning
Following on from the priorities and operational planning guidance the NHS published in October 2021, further planning priorities for 2022/2023 were also published in December 2021. This latest priorities document can be viewed here. This includes an increase in Advice and Guidance from 12 to 16 requests per 100 outpatient first attendees by March 2023. Additionally, one of the new aims is to have 5% of all outpatients moved or discharged to a Patient Initiated Follow ups (PIFU) pathway. The BAD’s PIFU guidance can be found here.
Taking a longer term view, the government has announced significant additional funding for the NHS over the next three years. Government has agreed an overall financial settlement for the NHS for the second half of the year which provides an additional £5.4bn above the original mandate. This includes, £1.5bn funding (£1bn revenue and £500m capital) to support the continued recovery of elective activity and of cancer services.
All organisations should agree a plan identifying those specialities and procedures they will begin their restart with. This can be determined by urgency of procedures, delayed procedures, and the demographic (e.g., paediatrics). This list is not exhaustive and will be agreed locally with the Trust and department’s management team. All this is dependent upon the availability of specialist staff. Possible or confirmed cases of COVID-19 should be placed at the end of a list where feasible. [1]
Although elective surgeries resumed in the UK (and many other countries) in mid-2020, most hospitals are functioning at substantially reduced capacity, which translates to an ever-lengthening waitlist. As of September 2020, nearly 140,000 patients in England alone had been waiting for more than a year for their surgeries—100 times the number in 2019. [2]
It is crucial that experienced staff are available to carry out dermatology procedures. Prioritisation must be given to returned staff who have been working on COVID wards including ITU back to outpatient services. These staff members may have feelings of stress and fatigue and may require additional support; they may also require childcare support if hours are extended.
[1] Restart of Elective Surgery after a Pandemic (COVID-19). The Association of Perioperative Practice. 2020.
[2] Too long to wait: the impact of COVID-19 on elective surgery. The Lancet Rheumatology. Feb 2021.
Also in this section
Staffing and Facilities Guidance
Serious Incidents and Never Events
Private Practice
National Reform of Cancer MDT Meetings
Patient and Public Involvement
NHS Success Measures for Restoring Urgent Services:
1. Restore demand coming into the system to at least pre-pandemic levels. The number of patients to be seen in a first outpatient appointment following urgent GP referral will have returned to at least pre-pandemic levels.
2. Reduce the number of people waiting longer than they should for diagnostics and/or treatment at least to pre-pandemic levels on both screening and symptomatic pathways. The number of patients waiting more than 62 days after urgent referral will have returned to at least pre-pandemic levels.
3. Ensure sufficient capacity to manage future increased demand, including for follow-up care.
It is important to discuss the risks and benefits of changing treatment regimens or having treatment breaks with patients, their families and carers, and reach a shared decision when reprioritising waiting lists. This is important for patients who may need to remain longer on a waiting list.
The NHS has released new guidance for diagnostic waiting lists, following the publication of the guidance on surgical waiting lists. The waiting lists focus on patient needs and communication, you can access this via the button below.
Restoration of Service Statement from the BAD/RCP
The BAD has published guidance for COVID-19 phase 2 recommencing of services, diagnoses and interventions for major and common skin disorders. This is available here and has been co-badged with the RCP (consult@rcplondon.ac.uk):
Use of Artificial Intelligence (AI) During the Pandemic
At the present time, AI is being used more often than before due to the pandemic increasing the need for non-face-to-face interventions. The BAD supports its use in dermatology, as long as there are appropriate measures in place to ensure that it is vetted and regulated before and during use. Medical devices that use AI for diagnosis or treatment purposes need to be approved by the MHRA first. It is important to assess and evaluate the need for AI in dermatology before a service may use it.
The BAD’s position on Artificial Intelligence (AI) can be found here.
