Consultant physicians working with patients - Royal College of ...

Consultant physicians working with patientsinflammatory skin diseases such as psoriasis, eczema investigation of photodermatoses, which affect 18%and acne. They can enhance care but there is noof the population reducing quality of life,evidence that they reduce secondary carepsychological welfare and employabilityreferrals. management of skin problems in hospital patientswith other illnesses, thereby reducing length of stayIntermediate services(LOS)GPs with a special interest (GPwSIs) in dermatology can skin cancer screening for organ transplantprovide effective intermediate care for individuals with recipientschronic mild/moderate inflammatory diseases, skin genital skin diseasesinfections, sun damage and certain skin cancers as part management of genodermatosesof an integrated consultant dermatologist-led team. 6 cutaneous infections, tropical diseases and HIV skinThere is no good evidence that these services reduce diseasessecondary care referrals or save money; they may cellulitis day-case services producing substantial‘de-skill’ GP colleagues. 7,8 There are detailed DH safety, NHS savingsgovernance and training guidelines for the accreditation teaching, training and assessment of medicalof GPwSIs, which some primary care trusts (PCTs) students, GPs, trainee dermatologists and otherignore, risking patient safety.healthcare professionals collection and analysis of clinical data, clinical auditSecondary care servicesand compliance with clinical governanceSecondary care dermatology services receive 882,000 requirementsreferrals each year in England (approximately 16 per clinical research including therapeutic trials1,000 population). 9 Up to 50% of referrals relate to skin contributions to the wider NHS including NICE,cancer. Specialist services include:Care Quality Commission, the RCP and BAD(producing guidelines, patient information and skin cancer clinics – dermatologists screen over 90% outcome measures).of skin cancer referrals, treat approximately 75% andreassure the remainder; the National Institute for Hospital-based services require at least one whole-timeHealth and Care Excellence (NICE) recommends equivalent consultant dermatologist per 62,500that high-risk BCCs (the majority of cases) are population (see section 8). SAS doctors form an integraltreated in secondary carepart of the hospital team. Departments require the facilities for dermatological surgery, cancersupport of pharmacists and trained specialistmultidisciplinary teams (MDTs) and data collection dermatology nurses who meet competency standardscompliant with NICE guidanceset by their professional body, the British Dermatology medical dermatology for complex problems, often in Nursing Group (www.bdng.org.uk).TrainedMDT clinics with other specialties such asdermatology nurses can:rheumatology inpatient care of sick patients with severe skin treat patients in day-care units and on wards,diseases or skin failure, sometimes requiringprovide and supervise phototherapy, assist withintensive carepatch testing under consultant supervision, perform phototherapy (see BAD and Britishsurgical procedures, and care for wounds and ulcersPhotodermatology Group working party report), 10 provide patient information, demonstrate and applyiontophoresis, wound care and other day treatments treatments, dress wounds, remove sutures and day-case units for infusion of disease-modifying review follow-upsdrugs assist in operating theatres and advise patients paediatric dermatology services including laserundergoing surgerysurgery (see BAD and British Society for Paediatric advise and train professional colleagues caring forDermatology working party report) 11patients with skin diseases in the hospital/ investigation of cutaneous allergy and occupational communityskin disease by patch and prick testing (see BAD and with paediatric training, run hospital/outreachBritish Society for Cutaneous Allergy working party services for children with chronic skin disease.report) 12 Establish and run community clinics82 C○ Royal College of Physicians 2013