It is almost five years since we held the inaugural meeting of the DCE at the BAD. We came together because we all felt there was a critical need for our voice to be heard and more importantly to address the interests of the patients we serve. Our strength is in our large and diverse membership with representatives from almost every relevant patient support group, as well as from medical, nursing, and political groups and the pharmaceutical industry. We are all enormously grateful to the BAD who have continued to provide a natural base for our meetings and administrative support.
One of our major concerns remains the minimal emphasis on Dermatology for both undergraduate teaching in Medical Schools and GP Specialist Training programmes. Many doctors have become principals in General Practice with virtually no effective education in Dermatology. Not only does this result in poor treatment in Primary Care, but also an unnecessary burden on Secondary Care and commissioners. Patients often recognise that the care they receive from their family doctor is inadequate and turn to the relevant patient support group for advice. This advice should be complimentary to the advice they get from their GP, not a complete substitute for incompetence. Our specialist colleagues are struggling to meet the ever-increasing demand and this is not helped by the lowest per capita number of whole time equivalent consultants of all the G7 countries, apart from Italy.
This chronic lack of dermatologists has impacted drastically on the commissioning of Dermatology services by Clinical Commissioning Groups - many of whom are driven by a desire to see services delivered in community clinics. In many cases this has resulted in decommissioning existing knowledge pools in local acute trusts (which ironically may in fact be the closest setting for patients). An appropriate balance must be found between the ‘Care Closer to Home’ agenda and making the most out of existing centres of excellence. GPwSIs can play a crucial role in delivering this balance and in educating their primary care colleagues and hopefully, thereby reducing unnecessary referrals to secondary care. Rather than remaining fixated on service redesign, we believe that commissioners should focus on delivering effective and efficient pathways for patients that ensure that the right care is delivered at the right time in the right setting.
Dermatology is experiencing a renaissance of development with exciting and quite remarkable discoveries as our understanding of the immunology, genetics and pathophysiology of skin disease unravels. This is bringing unparalleled and phenomenal advances in treatments and improvements in the experience for patients with skin disease. Many of these treatments though are astonishingly expensive and that inevitably brings further challenges for an already over-stretched Health Service. Increasingly, crucial decisions regarding many of these treatments have become ‘delayed’ or ‘paused’ as the NHS struggles to meet its responsibilities.
Meanwhile, the ability to continue to prescribe relatively cheap, well-established and cost-effective treatments such as emollients for dry skin conditions, is at risk of being eroded by those who believe these should be bought over-the-counter by patients. These issues go to the very core of the principles of the NHS – free at the point of delivery and available to all.
The Council is here to offer support, experience and knowledge. Our mission is to help to disseminate best practice within the Dermatology community. We are keen to hear of any issues that you feel impact on the care of patients with skin disease.
The development of this website was kindly sponsored by the British Association of Dermatologists, who have no editorial control over its content.
Dr George Moncrieff