An acute trust that saw its adult dermatology service closed earlier this year fears its children’s dermatology service is also under threat.

  • Hospital consultants and private provider Circle have both said the commissioning of dermatology services had been “flawed”
  • Any further reduction in paediatric dermatology staff will “immediately” compromise service, trust warns
  • Existing model for dermatology provision “not sustainable”, says trust medical director
  • Independent review underway into the future of dermatology services in Nottinghamshire

The concerns come as HSJ learns that dermatology consultants at the trust and a manager at private provider Circle, which took on part of the specialist service, have described the commissioners’ decision to split adult and children’s services as “flawed”.

Nottingham University Hospitals Trust, one of the biggest teaching hospital trusts in England, was forced to scale back its acute dermatology service after five consultants left rather than transfer their contracts to Circle.

Trust chief Peter Homa

The trust ‘remains in discussions with commissioners’, Peter Homa said

The trust was forced to scrap acute adult dermatology services, including emergency services, from February due to a lack of staff.

The Nottingham provider has since raised concerns that its paediatric service, currently reliant on two full time and one part time consultant, is at breaking point due to an unsustainable service model and recruitment difficulties.

Trust chief executive Peter Homa told HSJ that with one consultant leaving soon, efforts to preserve the service will mean further reducing resources allocated to the trust’s adult service.

Mr Homa said: “Our two remaining dermatologists are supporting our endeavour to preserve our paediatric dermatology service, but this further reduction in consultants requires a further contraction in our already limited adult emergency dermatology service to inpatients.”

A trust document presented to Nottinghamshire County and Nottingham City Council’s joint health scrutiny committee in March said: “Any further reduction in [the trust’s] consultant numbers will immediately compromise the paediatric service.”

Trust medical director Stephen Fowlie told the committee that the service model for dermatology at the trust was not sustainable, and it would struggle to attract consultants back to the area.

Seven out of 11 consultants have left the service since Nottinghamshire commissioners awarded Circle a contract in 2013 that made it the main provider of dermatology services at the trust and the company’s Nottingham Treatment Centre.

One of the remaining dermatology consultants told the scrutiny committee that most of the consultants’ opposition to having their contracts moved across to Circle was the decision by commissioners to split child and adult inpatient services from other treatment areas, and was “nothing to do” with Circle being a private company.

She added: “The service model was flawed and needed to be remodelled for a sustainable service. The service could not be sustained without any colleagues.”

Helen Tait, general manager of the Nottingham Treatment Centre, told the meeting that “lessons had been learned”. She said: “There was a flawed split of adults and paediatrics and this had been a ‘novel’ experience in terms of procurement.”

Mr Homa said the trust “remains in discussion with commissioners and Circle about securing a future for all adult dermatology services in Nottingham”.

He added: “The trust has recently contributed to an independent review of dermatology services, which was commissioned by Rushcliffe Clinical Commissioning Group.

“We will act on any lessons to be learned for other services from the experience of dermatology and from the recommendations of the review.”

Vicky Bailey, chief officer for Rushcliffe CCG, which coordinated the original procurement, said: “All the relevant partners are working together to find a solution and the report, due for publication, will outline all the recommendations.”

The review will be published next month.