Parliamentary questions relating to the dermatology crisis in Nottingham, HEE training numbers, lack of National Clinical Director of Dermatology, reveiew of strategic clinical networks, prescribing specials and more…

Dermatology Questions & Answers January – February 2015

Most recent first:

Lilian Greenwood MP:

To ask the Secretary of State for Health, how many commissioning fact sheets have been produced by NHS England since 2013; and what plans NHS England has to produce a commissioning fact sheet for dermatology services.

To ask the Secretary of State for Health, what assessment he has made of the potential merits of introducing a National Clinical Director for Dermatology.

To ask the Secretary of State for Health, when the next review of strategic clinical networks will be undertaken; and if he will consider the merits of creating a dermatology-focused strategic clinical network.

Answered 23^rd February

Norman Lamb MP:

Since 1 April 2013, NHS England has published information factsheets for a range of purposes. The main factsheet resource for commissioners has been produced to provide the costs and benefits of 25 specific interventions to reduce premature deaths:

www.england.nhs.uk/ourwork/forward-view/sop/red-prem-mort/factsheets/

Although there are currently no plans to produce a commissioning factsheet for dermatology, National Institute for Health and Care Excellence guidance in areas such as eczema and psoriasis continues to help commissioners to deliver high quality dermatological care.

With regard to strategic clinical networks (SCNs), the first SCNs were chosen by NHS England using criteria developed with input from a broad range of stakeholders. These are initial groupings and it is expected that they will be expanded in the future. NHS England is undertaking a review of the role, purpose and function of the sub-regional infrastructure that it funds, which is focussed on supporting commissioners and providers to improve the quality of services including SCNs. This review is ongoing and is expected to reach its conclusions by the end of March.

NHS England currently has no plans to introduce a National Clinical Director for Dermatology. However, NHS England has established a clinical reference group for specialised dermatology to bring together clinical experts, patients and carers to share best practice and improve services for patients.

Lord Turnberg:

To ask Her Majesty’s Government what assessment they have made of the recent closing of the acute dermatological services at Nottingham University Hospital Trust and the impact it has had on the dermatology services to in-patients with acute medical and surgical conditions and on training capacity in the East Midlands.

The provision of services, including dermatology services, is a matter for the local National Health Service.

We are advised by the NHS Trust Development Authority that Nottingham University Hospitals NHS Trust has worked with commissioners to ensure a satisfactory service is available to local people from alternative providers and the Trust will continue to provide an out of hours service for its inpatients and those patients requiring emergency treatment.

Rushcliffe Clinical Commissioning Group has commissioned a review to assess what is needed to meet the needs of the population in the future.

This Government established Health Education England to co-ordinate education and training activity across the NHS, including the management of training programmes for junior doctors. Health Education England and the Local Education and Training Board in the East Midlands are best placed to work with local employers in Nottingham to understand and manage the impact of changes.

Answered 20^th February

Earl Howe:

The provision of services, including dermatology services, is a matter for the local National Health Service.

We are advised by the NHS Trust Development Authority that Nottingham University Hospitals NHS Trust has worked with commissioners to ensure a satisfactory service is available to local people from alternative providers and the Trust will continue to provide an out of hours service for its inpatients and those patients requiring emergency treatment.

Rushcliffe Clinical Commissioning Group has commissioned a review to assess what is needed to meet the needs of the population in the future.

This Government established Health Education England to co-ordinate education and training activity across the NHS, including the management of training programmes for junior doctors. Health Education England and the Local Education and Training Board in the East Midlands are best placed to work with local employers in Nottingham to understand and manage the impact of changes.

Lord Walton of Detchant:

To ask Her Majesty’s Government why the acute adult dermatology service at Nottingham University Hospital is to be closed; and whether they have assessed the effect that that decision will have upon patients in the area affected by skin diseases.

Answered 16^th February

Earl Howe:

The provision of services, including dermatology services, is a matter for the local National Health Service.

The NHS Trust Development Authority advises that since 2 February 2015 Nottingham University Hospital NHS Trust has not been able to provide a comprehensive adult dermatology service. It no longer has sufficient consultant dermatologist capacity to sustain such a service.

The Trust has worked with commissioners to ensure a satisfactory service is available to local people from alternative providers.

Rushcliffe Clinical Commissioning Group has commissioned a review to assess what is needed to meet the needs of the population in the future.

Baroness Finlay of Llandaff:

To ask Her Majesty’s Government how Health Education England calculates the number of trainees in dermatology; and how those numbers are matched to future specialist consultant requirements for England.

Answered 13^th February

Earl Howe:

The Government has mandated Health Education England (HEE) to provide national leadership on education, training and workforce development.

HEE sets out its commissioning intentions based upon the needs of local employers, providers, commissioners and other stakeholders who come together as members of HEE’s Local Education Training Boards (LETBs).

HEE’s national workforce plan for England is an aggregate of local LETBs’ plans, but the advice and input of clinical advisors and patient representatives, as well as the Royal Colleges and other stakeholders, is also listened to and considered. It is this discussion and involvement locally and nationally that makes this a plan for the whole of the National Health Service in England.

HEE is in the process of reviewing investment in medical education in the context of current and forecast supply and demand, competing priorities, the NHS Five Year Forward View, and HEE’s Strategic Framework.

To ask the Secretary of State for Health, what his Department’s policy is on the long-term use of locum consultants to run dermatology services in England.

Answered 16^th January

Daniel Poulter MP:

The Department expects National Health Service organisations to have a strong grip on their workforce planning and management across all their specialties including dermatology, making permanent appointments to consultant posts wherever possible. Via Monitor, the NHS Trust Development Authority and the Care Quality Commission, the Department is working with the NHS to reduce trusts’ reliance on temporary staffing including the long term use of locum consultants.

To ask the Secretary of State for Health, how many consultant dermatologists with (a) permanent contracts, (b) agency contracts and (c) other contractual or financial arrangements worked in the NHS on 13 January 2015.

To ask the Secretary of State for Health, how many vacant consultant dermatologist posts there were in the NHS on 13 January 2015.

Answered 16^th January

Daniel Poulter MP:

Information on vacancies is not collected by the Department. The last annual National Health Service vacancy survey in England was undertaken by the Health and Social Care Information Centre in 2010.

The survey was suspended in 2011 and then discontinued in 2013 following the publication of the Fundamental Review of Data Returns, which aimed to reduce the burden of the collection of data from NHS organisations.

Information on the number of consultant dermatologists who hold agency contracts and other contractual or financial arrangements is not held by the Department

The latest annual workforce census data, published by the Health and Social Care Information Centre (HSCIC), shows there were 486 directly employed consultant dermatologists working in the NHS in England as at 30 September 2013.

The next census will be published by the HSCIC on the 25 March 2015 and will provide data for September 2014.

To ask the Secretary of State for Health, how many consultant dermatologist training posts have been funded in each financial year since 2010; and what assessment he has made of the sufficiency of that number.

Answered 16^th January

Daniel Poulter MP:

Health Education England (HEE) has commissioned 177 specialty training places in dermatology in 2014/15 and intends to maintain this number in 2015/16.

Data on the volume of training places commissioned by strategic health authorities in the period before 2014/15 is not available.

HEE is responsible for workforce planning and education commissioning activity to ensure that the National Health Service in England has available a future workforce in the right numbers, with the right skills, values and behaviours this includes dermatologists.

HEE has recently published its second national workforce plan for England for the period 2015/16 which is built upon the needs of local employers, commissioners and other stakeholders who, as members of Local Education Training Boards have shaped the 13 local plans that are the foundation of the national plan for England. The priorities in the plan are the priorities of the NHS, identified locally and nationally by employers, colleges and other stakeholders.

Sir Paul Beresford MP:

To ask the Secretary of State for Health, what steps his Department is taking to curb excessive disparities in the cost of dispensing (a) dermatology and (b) non-dermatology preferred unlicensed dermatological preparations; and what steps he is taking to ensure that all pharmacies in England obtain a whole-of-market quote from manufacturers of such preparations, as is the case in Scotland.

Answered 12^th January

Daniel Poulter MP:

The Drug Tariff sets out what National Health Service dispensing contractors will be paid for the products supplied as part of providing pharmaceutical services and the fees for providing those services in primary care.

The current arrangements for paying for unlicensed medicines were introduced in 2011. These arrangements, unlike the ones for Scotland, do not require pharmacy contractors to obtain a whole-of-market quote from manufacturers. However, the Drug Tariff sets the price that the NHS pays to dispensing contractors for dispensing many of the most popular specials. Setting a reimbursement price, applied to all contractors, stops disparity of payment for these products and encourages dispensing contractors to obtain best value for the NHS, while also ensuring patients receive the medicines they need, when they need them. Due to the number of unlicensed medicines that can potentially be prescribed, it is not possible to list a reimbursement price for all available specials.

Where the reimbursement price of a product has not been set, dispensing contractors are paid according to how the product is sourced. Where a dispensing contractor buys the product from a specials manufacturer or an importing company, they must claim the invoice price of the pack size used to dispense the product minus any discounts or rebates received.

NHS England is responsible for commissioning pharmaceutical services in primary care and it is for NHS England to consider whether dispensing contractors have acted appropriately, including excessive claims for payment made by contractors. In addition, the General Pharmaceutical Council is responsible for regulating the pharmacy professions should there be any concerns of professional misconduct.