NHS Greater Glasgow: New Pathways to Access DermatologyServices
Gary Jenkins
NHS Greater Glasgow Factfile
Project Clinical Lead
Dr Colin Clark
(Dr Frieda Shaffrali)
Project Manager
Gary Jenkins
Revenue bid proposal outline Education and training package for GPwSI
Total Revenue Funding awarded
£60,000
Capital bid proposal outline
1. New ambulatory Dermatology Centre Western Infirmary Glasgow
2. Development of a Central Skin Cancer and Lesion Diagnostic and Treatment Centre
Total Capital Funding awarded £450,000
Routine waiting time at commencement
>26 weeks (86/1083 waiting at Stobhill)
Routine waiting time at 12/05 <26 weeks (0 waiting 26 weeks, 50/714 waiting 22-26 weeks)
Post-project status
GPwSI project funded for 2 sessions for further year, CHPs expected thereafter to evolve concept
Project Objectives Delivered
Revenue bid: Successful creation of an educational programme and development of a secondary care GPwSI clinic at Stobhill General Hospital with impact detailed below.
There were two capital proposals submitted to CCI for funding approval, these were:
1. Development of an Ambulatory Dermatology Centre in the North West of Glasgow: The purpose of the bid was to create a dedicated dermatology environment in comparison with the current delivery of the service across 3 sub-optimal locations. After debate and negotiation over possible sites, approval was given to develop the ADC on the Western Infirmary site.
The integration of the services has allowed the out patient clinics to be staffed with dedicated dermatology nurses, thus improving the efficiency and productivity of the clinics. Integration also creates more of team approach and enables enhanced utilization of staff.
Within the project budget we were able to create; eight Consulting rooms, one phototherapy suite, two Biopsy suites, two Procedure rooms, one Seminar room, two 'pooled' secretarial offices, seven offices, two patient waiting areas, one reception area, one nursing duty room and one senior nurse office.
2. Development of a Central Skin Cancer and Diagnostic and Treatment Centre: The aim of the bid was to streamline the management of skin cancers across Glasgow through the creation of a main cancer centre for Dermatology within the Southern General Hospital. The Directorate team have agreed that as a first phase we undertake a PSDA approach to assess the best approach for controlling the management of lesions and skin cancer. Approximately 50% of new referrals (approx. 11,000pa) are lesion related and in order to streamline melanoma work initially, we have agreed to pilot a dedicated direct referral form in order to assess our ability to track and manage suspected melanoma through a single channel via a new dedicated skin cancer clinic at the Southern General. Referrals will initially come from within the South and West zones of the city. If the study proves successful, we will extend the service to cover more zones of the city.
The creation of the hub unit has enabled the establishment of three Mohs surgery lists per week. Agreement has been reached for the non melanoma skin cancer clinic to transfer to the hub in the near future. The cutaneous T Cell Lymphoma clinic is also on site and established.
Did any of these initiatives fail?
I do not feel that any of the initiatives have proven to be failures. Implementation of the GPwSI initiative was delayed by agreement over the remuneration package in the absence of national guidance. Regarding redesign based on the capital developments, the Directorate has taken a more cautious approach than first anticipated on the channeling of all lesions through the hub unit. This however was in light of studying research on similar service models and following the publication of the Kerr Report, stating that services should be delivered as locally as possible.
How was the revenue funding spent?
Seven sessions per month of GPwSI time were purchased along with one additional session of Consultant time to manage the clinical aspects of the project.
How was the capital funding spent?
SAS funding provided £250,000 of the £500,000 build costs for the ambulatory unit development, and £200,000 of the £327,725 required to develop the central skin cancer and lesions diagnostic and treatment centre.
Additional patient activity delivered
The revenue bid from NHS Glasgow was developed primarily as an educational package with the GPwSI initially working under close supervision. However, 210 new patients were directly seen by the GPwSI over the initial twelve month period from January 2005.
The two capital projects have only recently been completed. The impact, in terms of activity, is not yet fully recognized. The longer term impact to quality and efficiency will be monitored throughout 2006/7. There was a separate capacity planning exercise undertaken to ensure that Dermatology had sufficient resources in place to achieve the waiting time guarantee.
Clinical Lead Summary
The overall experience for Dermatology has been positive. It was extremely helpful to be able to bid for dedicated funding in order to pilot new initiatives. This funding has allowed us to look at constraints of existing environments and take a clean sheet approach to how and from where service are provided. Attracting bid funding enables local services to debate with their health boards over supplementary funding to truly achieve service configuration to be proud of.
The national meetings were also helpful, in terms of sharing knowledge. It was useful to gain understanding of service provision elsewhere and debate similar projects with other managers and gauge their individual perspectives on areas of impact and planned outcomes. Absence of national guidance concerning GPwSI remuneration proved frustrating. Early concerns were flagged in relation to the English models, which had seen exorbitantly high sessional rates being offered. This led to cynicism in some areas over value for money, and some concerns around the ongoing provision of secondary care dermatology services.
In essence however, the overall project was remarkably successful regarding both the capital developments and the GPwSI training initiative.
There is no MMI data below that for Greater Glasgow and as the GPwSI activity was centred at Stobhill General Hospital, we include relevant data in Appendix 7.
Learning Points
1. Ensure you have a design team that understand the nature and needs of your service
2. Be realistic about what can be achieved. Have an understanding of the services you will be providing from your environment and ensure that all service users are signed up to the concept.
3. Be sure that you have sufficient ring fenced educational time available to develop the GPwSI to accommodate training time and mentorship by consultants.