COMMERCIAL: A dermatology contract negotiated by a primary care trust did not meet National Institute for Health and Clinical Excellence standards and left patients at greater risk of cancer, a report has concluded.
NHS Hillingdon failed skin cancer patients by using a contract which did not meet NICE standards over defining the patient care pathway, and holding an “inadequately rigorous” previous investigation, a multi-disciplinary investigative group set up by the primary care trust and the West London Cancer Network has found.
The primary care skin cancer review group uncovered evidence of patients not being referred on for treatment after a biopsy and poor performance of some GPs carrying out minor dermatological surgery.
The PCT had commissioned two private companies - identified by a PCT spokesman as the Practice PLC and 3fivetwo Healthcare - to provide dermatology community assessment and treatment services (CAT). Six months after the contract began in July 2008 the Hillingdon Hospital Trust reported “significant concerns” about the management of patients.
When the West London Cancer Network previously investigated the issue it found three serious untoward incidents and a further four potential SUIs at the service. The latest review said an additional 14 people received substandard care.
It said: “In two cases it is possible that the long-term outcome of the patients may be worse due to delays in treatment.”
The CAT service was suspended for new referrals in March 2009 and cancelled altogether a few months later.
The group has now reviewed the records of all patients who had a skin biopsy taken in CAT services or a GP surgery between January 2008 and June 2010 which revealed skin cancer to ensure they saw a specialist.
The report concluded: “The incident occurred because of poor commissioning and monitoring of the CAT services by the PCT and administrative and clinical under-performance by the CAT providers.
“It is not possible to give a categorical assurance that all mismanaged cases of skin cancer due to this incident have been identified. However, a thorough investigation has been undertaken and it is very unlikely that further cancer cases will come to light.”
“Authoritative guidance” on managing skin cancer has now been sent to the GPs saying they should not perform the biopsy themselves, the report said.
Dr Ellis Friedman, chair of the multi-agency investigation team and director of public health at NHS Hillingdon and Hillingdon Council, said: “We have learnt a number of important lessons from this incident. It occurred because the commissioning and monitoring of the service by NHS Hillingdon was not sufficient and there was under performance by the service providers.”
A spokeswoman for The Practice PLC said: “The report outlines a range of considerable contributing factors, from various different parties, which when combined led to unacceptable poor service standards for patients, however it is important to note that a number of factors were outside the control of the CATs providers.”