Thirteen national groups representing doctors, nurses and patients are calling for a government inquiry into the chronic lack of doctors working in dermatology, following responses to Freedom of Information data released today that highlight staff shortages and variations in waiting times.

In a letter to Dr Sarah Wollaston MP, Chair of the House of Commons Health Select Committee, the organisations urge the Committee to review a decision by Health Education England not to allow for an increase in the number of trainee doctors in the specialty.

The signatories, which include the All Party Parliamentary Group on Skin, British Association of Dermatologists, Royal College of General Practitioners (RCGP), British Dermatology Nursing Group, as well as charities including DEBRA, Changing Faces, National Eczema Society and Psoriasis Association, cite newly released Freedom of Information (FOI) figures obtained by one of the co-signing groups, Dermatology Council for England.

Two-thirds (66 per cent) of trusts responding to the FOI request reported that they had consultant dermatologist vacancies. However, Health Education England (HEE) is funding just 177 specialty training places in dermatology in 2014/15, a reduction from the previous 178 posts. This means that with fewer trainees coming up through the ranks to replace retiring staff, there will be no scope to increase Consultant numbers.

Steps taken by trusts and CCGs to try to alleviate the void in consultants are themselves problematic, and no substitute for increased consultant numbers achieved through increased training posts.

71 per cent of trusts said they were using locum consultants to maintain services. Furthermore, while locums are meant to be a short-term solution to temporary staff shortages, 52 per cent of trusts employing locum consultants have had them in post for between one and four years, while 19 per cent had employed individual locums for more than four years.1

Recent reports have disclosed that the NHS paid £3.3bn last year for temporary agency staff, compared to £1.8bn in the past three years.
Almost half of trusts employing locums (48 per cent) were employing at least one that was not on the specialist register. In the UK, this register indicates when a doctor has completed training to the standard required to become a consultant.

The data also exposes the detrimental impact on waiting times and patient care For trusts with vacancies, the average waiting time for urgent referrals, but not subject to the two-week waits for cancer, was seven weeks, with urgent waiting lists as long as 19 weeks reported.

Half (104) of the CCGs who responded were commissioning community services staffed by GPs with a Special Interest in Dermatology (GPwSI). GPwSIs are GPs who have additional training and experience in a particular specialty, in this case dermatology. These services are often set up to try to alleviate the pressure on consultant dermatologists and increase the access to dermatological expertise within the community setting.

However, at least 29 per cent of these services were using GPs who did not fully comply with NHS guidance on good clinical practice for the provision of such a service.

The letter to the Health Select Committee, the body responsible for examining the work of the Department of Health, also refers to an independent report last month into the collapse of a dermatology service in Nottingham due to lack of staff and poor commissioning decisions. The report highlighted the need for Health Education England to review the funding available for dermatology training posts – a call to action that the Health Select Committee is being asked to consider, either within the context of dermatology specifically or as part of a larger review of the NHS’ workforce planning capability.

President of the British Association of Dermatologists Dr David Eedy said: “We hope this FOI data will prompt the Health Select Committee to look into the illogical decision by HEE to reduce our trainee numbers. Trusts are struggling to cope and efforts being made to bypass the need for consultants are clearly failing. Relying on locums is not a viable solution, and not just owing to the greatly increased cost to the NHS. Many locums may have trained abroad where clinical standards and guidelines differ widely from those in the UK, but the public are simply being told they are seeing a consultant, which is grossly misleading.”

The Dermatology Council for England is auditing all 209 CCGs and 54 trusts, chosen at random from each of the regions covered by NHS England’s former area teams. This interim report is based on responses received to date, from 204 CCGs and 38 trusts. Figures will be updated when the final responses have been received and processed.

Dr George Moncrieff, GP and Chair of the Dermatology Council for England said: “This report describes a dermatology service in meltdown. There has been an insidious over-dependence on expensive locums, many with foreign qualifications or not even on the specialist register, with alarming consequences.

“Sadly, after years of neglect to their teaching and training in dermatology, we cannot turn to General Practitioners to provide the solution. GPs have had, at most, just one or two weeks teaching in dermatology during their entire time at medical school. The Deaneries responsible for specialist training for these future GPs, provide virtually no further formal dermatology training. That is extraordinary when skin disease is such a large part of the everyday workload of a GP and results in about 15 per cent of the entire workload of a GP.

“Worryingly, the inevitable time lag between making effective changes and establishing a suitably qualified Primary Care workforce and adequate numbers of appropriately qualified dermatologists, will be measured in decades. This report demonstrates a service that has decayed relentlessly over the last ten years. It is imperative that we act now to address this crisis.”

-Ends-

Notes to editors:

For more information please contact: Nina Goad, Head of Communications, British Association of Dermatologists: comms@bad.org.uk
Website: www.bad.org.uk

*The full results of the FOI requests will been available to view on both the Dermatology Council for England and APPGS websites: http://www.appgs.co.uk/dermatology-council-for-england-releases-foi-report-july-2015/

** The full signatory list for the letter to the Health Select Committee is as follows:
Sir Paul Beresford MP, Chair, All Party Parliamentary Group on Skin
Dr David J Eedy MD, FRCP, President, British Association of Dermatologists
Professor Nigel Mathers, Honorary Secretary, Royal College of General Practitioners
Dr Stephen Kownacki, Chairman, Primary Care Dermatology Society
Karen Stephen, President, British Dermatological Nursing Group
Margaret Cox, Chief Executive, National Eczema Society
Claire Mather, Director Healthcare, Membership, and EB Community Support, DEBRA
Dr George Moncrieff, Chair, Dermatology Council for England
Helen McAteer, Chief Executive, Psoriasis Association
James Partridge, Chief Executive, Changing Faces
Fred Frederiksen, Vitiligo Society
Nigel Scott, Herpes Virus Association
Julie Halford, Hyperhidrosis UK

1 Many trusts employed more than one locum for different lengths of time, as such the percentages given will not total 100%.

The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease.