Research due to be presented at the British Association of Dermatologists’ Annual Conference in Liverpool next week (July 8th – 11th) will highlight the importance of on-call dermatology services and the need to protect these services from NHS cuts.

On-call dermatology services are regularly used by other hospital specialists and GPs and are highly valued, not least because non-dermatology specialists and generalists have little confidence in correctly identifying and managing dermatological emergencies.

Three studies will highlight the importance of out-of-hours and emergency dermatology provision in hospitals and the risks to patients inherent in cutting these services.

One study, by researchers at St George’s Hospital in London, showed a worrying lack of knowledge and confidence in the management of acute dermatological emergencies by non-dermatology professionals.

The researchers asked a group made up of GPs, non dermatology specialists and trainees to identify a dermatological condition from a case vignette and image. 23 per cent of hospital respondents (non-dermatology) correctly identified the dermatology emergency compared with 85 per cent of dermatology trainees and 43 per cent of GPs. These results by specialty were: paediatrics 52 per cent, general medicine 22 per cent, emergency medicine 22 per cent, intensive care 15 per cent and obstetrics and gynaecology five per cent.

Respondents were asked to rate their confidence in managing each condition. Overall, only one per cent of non-dermatology hospital specialists strongly agreed with the statement “I would feel confident initiating treatment, instructing nursing staff and managing” patients with acute skin conditions, and 44 per cent strongly disagreed with this statement. In contrast 39 per cent of dermatology trainees strongly agreed with the statement and two per cent strongly disagreed.

Regarding support for out-of-hours dermatology provision, 82 per cent of GPs and hospital specialists valued the service. The remaining eight per cent thought this was service was “possibly helpful” and no respondents chose the option “cannot see the need”.

Dr Vanessa Pinder, one of the St George’s study’s authors, said: “Our study shows that general medicine is not well equipped to manage dermatology emergencies. There was poor recognition of emergency dermatological presentations, with a lack of confidence in managing potentially life-threatening conditions. Despite this, on-call dermatology is under threat, with an increasing number of hospitals no longer providing emergency cover. These changes have been made with scant regard for how dermatological emergencies will be managed. With the increasing financial pressure on the National Health Service this trend is likely to continue, and dermatology is particularly vulnerable as the potential for skin disease to cause life-threatening and serious illness is not well recognized.”

Two further studies involved audits of all urgent, on-call referrals to Dermatologists and found that, despite pressure to cut on-call care, it offers a crucial service for patients, as well as invaluable training experience for junior doctors.

The first study was carried out at Northampton General Hospital over a four-month period (September to December 2012). Referrals here are made to a dermatology registrar in a district general hospital, with no out-of-hours, on-call service.

The total number of referrals was 63, with the vast majority from other hospital specialties requesting an inpatient review (medical specialties 59%, surgical specialties 21%, paediatrics 5% and intensive treatment unit 3%), followed by the emergency department (9%) and other specialty clinics (rheumatology and haematology: 3%).

68% of patients were seen on the same day, 24% within 24 hours and 6% within 72 hours, the remaining 2% were seen within one week of referral. In 63% of cases the referral asked for identification of a rash, 10% queried diagnosis of a lesion, 10% requested a review of an existing dermatological condition and 16% requested support with the diagnosis and management of leg ulcers.

The second study looked at 90 on-call referrals over a 10-week period (September 2012 to November 2012) at Portsmouth Hospitals NHS Trust. They found an even distribution between referrals from secondary care (53%) and primary care (47%). Of the inpatient referrals received, the majority were from medical departments (77%), followed by paediatrics (7%), intensive care (7%), surgical departments (3%), emergency department (3%) and obstetrics and gynaecology (3%). Of all the referrals received, 49% required an urgent outpatient appointment, 33% required inpatient review and 18% telephone advice.

Nina Goad of the British Association of Dermatologists said: “Hopefully these audits will help to demonstrate to commissioners and managers that on-call dermatology services are greatly valued, by clinicians and patients alike. They are also a vital training tool for registrars. There is a misapprehension that dermatology does not warrant emergency or out-of-hours provision, but this fails to recognise the severity of many skin issues, such as drug reactions. To limit on-call services would be to the detriment of other hospital departments and most importantly to patient care.”

-Ends-
Notes to editors:

If using this study, please ensure you mention that the study was released at the British Association of Dermatologists’ Annual Conference.
The conference will be held at ACC Liverpool from July 9th to 11th 2013, and is attended by approximately 1,300 UK and worldwide dermatologists and dermatology nurses.

For more information please contact: Nina Goad, Head of Communications, 0207 391 6094 (or mobile 07825567717 during conference week only) or Deborah Mason, Communications Manager, Phone: 0207 391 6355, Email: comms@bad.org.uk, Website: www.bad.org.uk

Study details:
P33: An audit of acute dermatology referrals at a district general hospital, B. Shaheen and C. Soon, Northampton General Hospital, Northampton, U.K.
P34: Dermatology on-call service: is it really necessary? N. Anjum, L.H. Lee, A. Haworth and B. Hughes, Portsmouth Hospitals NHS Trust, Portsmouth, U.K.
P37: An audit to support the need for emergency dermatology training, V. Pinder, F. Worsnop, J. Wee and L. Ostlere, St George’s Hospital, Tooting, U.K.

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.