Exclusive: Memo reveals trust forced to 'scale back' specialist service

An internal memo from trust chief executive Peter Homa, which has been seen by HSJ, revealed the extent of the “scaled back” dermatology service at the trust. The service collapsed after five consultants left rather than transfer to the nearby Circle run treatment centre.

In 2013 Rushcliffe Clinical Commissioning Group decided to transfer elective dermatology services to Circle despite concerns from the trust, its 11 consultants and the British Association of Dermatologists.

The internal memo, which was sent to all consultants, ward managers, site matrons and emergency department staff on 30 January, informed them that from 2 February the trust was “no longer able to provide a comprehensive adult acute dermatology service”.

It said it would instead offer a “scaled back” service, following discussions with commissioners, which will remain in place up to May while talks on a longer term solution continue.

The memo said: “An urgent service for GP and emergency department referrals and for ambulant, non-infectious, NUH inpatients will be provided by the treatment centre Monday to Friday, in-hours. Adults who require specialist dermatology admission will be cared for in Leicester.

“For NUH inpatients and for ED (weekends), a very restricted NUH based service will be provided. Same day opinions may not be available.”

Mr Homa praised staff for their commitment during what he described as a “particularly difficult period for the service and specialty”.

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The trust still provides a comprehensive paediatric dermatology service via the three consultants who remain in post.

A spokeswoman for the trust said it expected only one patient a month would have to travel to Leicester for treatment and the trust has around 35 dermatology inpatients each month. She confirmed the trust was “unable to provide its previous comprehensive acute adult dermatology service because we no longer have enough consultant dermatologists to sustain such a service”, adding that the changes amounted to “a very limited risk” for patients.

David Eedy, president of the British Association of Dermatologists, told HSJ: “Patients’ needs don’t only apply during office hours, which is why medical care can’t either. We have to question the decision by the commissioner to separate out adult acute and adult elective services within recognised acute service frameworks.”

He added: “There appears to have been no impact assessment or consultation on the outcomes of these commissioning decisions, despite these being raised by the [association] and local consultants at the time.”

Vicky Bailey, chief officer for NHS Rushcliffe CCG said: “The clinical commissioning group has reached an interim solution with NUH to give patients who present with acute dermatological problems outside of normal hours the safe levels of care they need.  We are planning to commission a separate independent review to assess the future of the overall service so it can meet the long term needs of the population into the future.”