We welcome the report which we feel summarises the series of errors that led to the collapse of key dermatology services in Nottingham. We agree that all involved parties must now work together to improve patient care and to rebuild services in the region. However, it is also crucial that the failures outlined in the report are accepted and learnt from. The CCGs claim that the health of Nottingham’s citizens has been improved by the Circle service but it is hard to see how this is the case, given the destruction of what was previously a world renowned centre of excellence, the critical comments from patients in the report, and the current lack of key dermatology services. The commissioners have also claimed that the NUH service collapse was down to an employment issue rather than a commissioning issue, suggesting a failure to acknowledge the role of their own questionable commissioning decisions – such as preventing NUH setting up a separate specialist service that would have helped to retain specialists in Nottingham – that triggered the ‘employment’ problems they refer to. If CCGs deny accountability when services fail, our fear is that devastating contracting decisions will continue to be made, and it cannot be claimed that lessons have been learnt.

Circle admits that now they are saddled with the high costs of employing locums, it is likely that their service is not financially sustainable. This is a depressing indicator of things to come. The consultants who left Nottingham have not been asked to contribute to the report and it is important to establish why dermatologists have felt driven to move their families and jobs away.

The problems in Nottingham are compounded by decisions taken at a national level. Despite a deficit of more than 200 Consultant Dermatologists across the UK, Health Education England has refused to allocate further training posts for dermatology. This means that we do not have enough trainees coming up through the ranks to replace retiring Consultant Dermatologists. While we appreciate that the time-lag involved in training does not provide a quick fix for the current crisis, the fact that training numbers are not increasing suggests that the Consultant workforce deficit will be plaguing patients with skin problems in many parts of the UK for years to come.

It is also worrying that doctors who do not possess the same certification required of consultants on the Specialist Register, can legally be appointed locum consultants. For the NHS, these locums come at a hugely increased cost, as demonstrated in Nottingham. For the patient, this means that many posts in dermatology are held for long periods by someone not possessing the same qualifications as a substantive UK accredited Consultant. They may have trained abroad where clinical standards and guidelines differ widely from those in the UK. The use of the word ‘Consultant’ dupes patients into believing that these locums have been trained to the level required to enter the Specialist Register, which may not be the case.

The report makes for grim reading but, provided all involved can take responsibility for their errors, it may help to prevent spurious commissioning decisions decimating dermatology services elsewhere.