• Birmingham Women’s and Children’s Foundation Trust has stopped accepting new referrals to its paediatric dermatology service
  • The decision comes amid “severe capacity” problems and a shortage of consultant dermatologists at the trust
  • GPs told to refer to primary care run community dermatology services instead

Birmingham Women’s and Children’s Foundation Trust has stopped all new referrals to one of its paediatric specialities due to “severe capacity” problems, local GPs have been told.

In a letter, sent this week by Birmingham and Solihull Clinical Commissioning Group, the area’s GPs were warned the trust would not accept referrals to its paediatric dermatology service after 3 May.

This is due to a lack of consultants working at the trust and a growing backlog of both new and follow-up appointments.

GPs in Birmingham have been advised to refer patients to the local community dermatology service, run by large GP provider Modality, while GPs in Solihull were advised to refer to another primary care based dermatology service.

In a statement to HSJ the trust said it was still accepting tertiary and quaternary patients to its service, however had agreed to stop secondary care referrals until 31 October. 

The letter, seen by HSJ, said: “In recent weeks, the CCG has been meeting with colleague from Birmingham Women’s and Children’s Hospitals Trust paediatric dermatology department to review the current severe capacity constraints.

“At present the trust has only two consultants providing dermatology services – 1.2 whole time equivalent, plus some nurse specialist capacity…

“Unfortunately, this is both a local and national consultant capacity issue in paediatric dermatology. GP referrals to BWC are 70 per cent of total referrals although referrals have fallen slightly in the last 12 months the limited consultant capacity has led to growth in the backlog waiting times for both new and follow-up appointments.

“The wait for a first outpatient consultation in February was 36 weeks but as of now, allowing for unbooked referrals that have been accepted, this has risen to 45 weeks. In addition, there is a large follow up waiting list of patients that the team must monitor.”

It adds that as neither providers nor CCGs are allowed to plan for waits above 52 weeks the trust had agreed to stop accepting referrals. 

A spokesman for the British Association of Dermatology told HSJ: “There is a significant shortage of dermatologists in the UK. Although some areas are struggling to recruit dermatologists more than others, the picture across the board shows that there are simply not enough consultants.

“Analysis suggests that in England there would have to be a 28 per cent increase in current staffing levels to reach the recommended baseline target ratio of one full-time consultant dermatologist per every 62,500 of the population.

“There isn’t a shortage of doctors who want to be dermatologists, but unfortunately dermatology is allocated a limited number of trainees every year.” 

A spokesman for Birmingham Women’s and Children’s Foundation Trust said: “After discussions with commissioners it has been agreed to ask GPs to refer secondary care dermatology patients to their local general paediatric service for a period of six months until 31 October 2019 to allow us to concentrate on the tertiary and quaternary patients that can only be seen by our specialists.

“As such, we will continue to accept referrals from other hospitals throughout this period, and help and support our colleagues in primary care in any way we can.

“The service is continually reviewing patients currently on waiting lists to mitigate risk; ensuring those in need of urgent or acute care are prioritised.”

A spokeswoman for Birmingham and Solihull Clinical Commissioning Group said: [The CCG] is continuing to work closely with Birmingham Women’s and Children’s Foundation Trust on this issue; and is exploring opportunities to expand the advice and guidance and tele-dermatology support to our GP practices during and beyond this period.” 

This story was updated at 13:32 with to reflect the trust’s clarification on referrals it will still accept to the service and with comment from Birmingham and Solihull CCG.