One of the biggest teaching trusts in England has been forced to axe its once renowned acute dermatology service following an “exodus” of medical consultants following the transfer of their contract to private provider Circle.
Nottingham University Hospitals Trust has confirmed it will cease to provide acute adult dermatology services – including emergency services – from February next year, due to a lack of staff.
The workforce crisis comes after Nottinghamshire commissioners awarded Circle a contract that made it the main provider of dermatology services delivered across the trust and Circle’s Nottingham NHS Treatment Centre.
The trust’s own bid for the contract was unsuccessful and the services were passed to Circle last year, despite warnings from the trust’s 11 dermatology consultants that senior staff would leave rather than be transferred out of the NHS.
Prior to 2013, the consultants had all been employed by the trust under NHS contracts, but provided outpatient services and some surgery at the treatment centre under secondments.
Under the new contract, most of the consultants faced moving to Circle under the transfer of undertakings protection of employment regulations, known as TUPE.
A March 2013 letter from the consultants sent to Rushcliffe Clinical Commissioning Group, seen by HSJ, predicted the transfer would result in a loss of consultants “within a 12 month period” and noted Circle had experienced difficulty in recruiting consultants directly.
They warned that this loss would mean “our patients are at risk, and teaching, training, research and the overall clinical service for our colleagues in Nottingham and regionally will suffer”.
They noted that the department at the time saw 3,000 patients a month – including those with complex skin cancers and complicated medical dermatology – and employed national authorities on a range of skin conditions.
A subsequent letter from Rushcliffe CCG, also seen by HSJ, said it was unaware of any materially detrimental change of working conditions that would result from the service transfer, and therefore consultants would have to transfer or face “terminating their employment”.
HSJ understands that five of the 11 consultants left rather than transfer to Circle, and of the three that did transfer only one remains in post. Three remain employed by the trust to provide paediatric dermatology, which was not transferred to the private company.
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A trust spokesman said: “It is with very deep regret that following the loss of a number of our remaining consultants to other centres and retirements since this transition in 2013, from early next year the trust will no longer be able to provide an acute adult dermatology service to new patients.
“This includes an emergency dermatology service, which is presently run by the NUH clinical team.”
David Eedy, president of the British Association of Dermatologists, said the problems were the result of “poor commissioning decisions”, which he said “resulted in an exodus of staff which, in my view, should have been predicted had the views of the consultants been taken on board during the procurement”.
He added: “I am very concerned about the immediate sustainability of Nottingham University Hospitals’ tertiary services, and its capacity to continue receiving national and local referrals for patients requiring acute and specialised care.”
Helen Tait, general manager of Circle’s Nottingham treatment centre, said the company had taken on dermatology as it was “a central part of the treatment centre contract”.
She continued: “Where staff transferred to us, we worked hard with commissioners and other providers to ensure the process was smooth, and that our contract complemented other services.
“Dermatologist recruitment is difficult across the country. But we’ve recently hired full time staff at the treatment centre, and we see no good reason why Nottingham should not remain strong in both acute and elective dermatology and maintain its reputation for teaching, training and research.
“The treatment centre continues to provide a comprehensive adult dermatology service, and we will join the CCG’s discussions with NUH about finding a solution. These discussions are in the very early stages and speculation on their outcome would be unwise.”
Vicky Bailey, chief officer for Rushcliffe CGG, said: “We have been in dialogue with the trust and Circle about the issues raised and we will work with both parties to make sure that we continue to maintain quality dermatology services for our population into the future.”