NHS Ayrshire & Arran: Redesign of Dermatology Services
Dr Colm Dwyer
NHS Ayrshire & Arran Factfile
Project Clinical Lead
Dr Colm Dwyer
Project Manager
Sinclair Molloy
Revenue bid proposal outline Redesign initiatives to ensure patients receive clinically effective care with minimal delay, focused around GPwSI and nurse-led clinics
Total Revenue Funding awarded
£60,000
Capital bid proposal outline
Refurbishment of clinic space to permit additional clinical activities of revenue bid
Total Capital Funding awarded
£250,000
Routine waiting time at commencement
59 weeks
Routine waiting time at 12/05
<26 weeks
Post-project status
Recurrent funding for nurse led initiatives GPwSI funding to be re-evaluated annually
Project Objectives Delivered
1. Nurse prescribers now operate acne clinics supporting retinoid therapy.
2. Three Nurse Biopsy Specialists perform many of our minor surgical procedures. Two further nurses are in training with the intention of setting up One-stop lesion clinics.
3. Specialist Nurses provide the majority of chronic care management for patients with psoriasis and eczema. One reflection of their success is that children now rarely need to be admitted for in-patient treatment.
4. A senior Nurse sees new patients suffering from acne, psoriasis and eczema, increasing throughput of new referrals and shortening waiting times.
5. Two Nurse-led photodynamic therapy sessions are held weekly, treating malignant and pre-malignant skin lesions and reducing referrals to the plastic surgery service.
6. A GPwSI service was set up, contracted to take 400 referrals per annum. Referrals are selected by consultants. The service has not yet been formally evaluated but experience to date indicates that it is very acceptable to patients and GPs.
All initiatives have been very successful. However, the GPwSI enhanced service contract has only been operating for three months and formal evaluation of this pilot initiative is not expected until January 2007.
Did any of these initiatives fail?
There have been no significant failures. The capital planning proved to be very slow and difficult due to the uncertainties surrounding a comprehensive review of services, the need to find a place in the already overcrowded capital programme, and delays in execution and delivery, in part due to contractor difficulties.
How was the revenue funding spent?
The revenue received was primarily used to fund the GPwSI initiative. However, £188,000 recurring funding was secured in 2005 to meet the cost of nurse led initiatives and to provide support for an additional consultant.
How was the capital funding spent?
Heathfield Clinic and Crosshouse Hospital have gained additional consulting, biopsy and treatment rooms. These developments facilitated recruitment and the expansion of the roles of nurse specialists.
Additional patient activity delivered
The Nurse led clinics have been operational since November 2004, whilst the GPwSI clinical activity has only been operational for three months. In the initial three months of the service the GPwSI saw 94 new patients with only six fail to attends, consistent with the projected capacity of 400 new patients per annum.
We have achieved reduced waiting times for new patient referrals. In April 2004 there were over 500 patients waiting in excess of 26 weeks, with some waiting up to 59 weeks. From June 2005 no patient has waited more than 26 weeks and there has been steady progress since then towards the 18 week maximum waiting time target. The department remains understaffed with 2.6 WTE consultants out of a planned complement of 4.0 WTE. However, we have managed to broadly maintain new patient throughput with the help of twelve additional locum consultant clinic sessions per month throughout the year.
Clinical Lead Summary
The funding for capital development has allowed the department to develop a number of initiatives and overcome long standing restrictions. In particular our nurses have expanded their roles to the benefit of our patients.
We are pleased with the operation of the GPwSI service. The educational events organized by Skin Action Scotland were valuable in selecting the parameters of this service. The training events on waiting list management were informative and influential.
Learning Points
1. Secure top level support for developing extended role nurse practitioner services
2. Departmental team working towards shared goals
3. Seek top level support at an earlier stage to overcome delays and obstacles
NHS Ayrshire & Arran Dermatology
