Scottish Dermatological Society

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SCOTTISH COUNCIL ON DERMATOLOGY

The Scottish Council for Dermatology was established in 2001 to provide expert advice on service provision for treatment of patients with skin disease in Scotland. It was formed by agreement between the organisations representing dermatology and dermatologists in Scotland, the British Association of Dermatologists and Scottish Dermatological Society, and represents the views of members of both. To ensure that its advice can be comprehensive, it includes representatives of nursing, general practice, and patient support groups.

Council Members

The elected members of the Council include the Presidents of the British Association of Dermatologists and of the Scottish Dermatological Society along with dermatologists from teaching and district hospitals. There are nominated representatives from the Primary Care Dermatology Society, British Dermatological Nursing Group, and Skincare Campaign Scotland. The adviser in dermatology to the Chief Medical Officer, Scotland and the dermatological representative of the Scottish Royal Colleges of Physicians are ex-officio members. The Council is chaired by the President of the Scottish Dermatological Society who also represents Scotland on the Executive Committee of the British Association of Dermatologists.

Current Members:

Member

Representative

Christopher Bunker

BAD President

David Bilsland

DCS Chair and SDS President

Daniel Kemmett

SDS President Elect

Anthony Ormerod

Scottish Training Director

Mozheh Zamiri

DGH representative

Margaret Nicol

SDNS Representative

Richard Weller

BSID Representative

Stewart Douglas

SCC  Scotland

Clare Fitzsimons

CMO Representative (co-opted)  

Colin Johnston

GP representative

Contact Information:

Monica Parrondo
Committee Administrator
British Association of Dermatologists
4 Fitzroy Square
London W1T 5HQ
Tel: 020 7391 6071
Fax: 202 7388 5263

Email: Monica@bad.org.uk

Skin Disease and Dermatologists

Skin diseases are disfiguring, distressing and highly symptomatic. One in four of the population are affected by skin disease that would benefit from medical care. Chronic inflammatory skin diseases significantly reduce quality of life and impose a considerable burden on the individual and the community.1 2 3 In the UK skin diseases are among the commonest certified causes of incapacity to work. Skin cancer is the commonest cancer in the UK; some estimate quadrupling in incidence in the past 20 years.

Skin disease accounts for some 15% of primary care consultations, 35% of the disorders under consideration for nurse prescribing, 7% of all referrals to hospital outpatient clinics. It is an increasingly important cause of serious debility in the elderly. Between 1981 and 1991 consultations for skin disease in general practice rose by almost 50%, yet only 6% of GPs have Certificates of Dermatology experience during their training. This reflected an increase in prevalence of common problems such as atopic eczema, venous leg ulcers and skin cancer as well as an increase in availability of effective treatments.4 GPs refer 1-2% of the population to dermatologists each year as new patients.

Dermatologists are hospital based specialists who diagnose and manage significant and complex skin disease in people of all ages. Most dermatologists are skin surgeons as well as physicians. Skin cancer is the commonest cancer in Scotland and is steadily increasing. Cure rates are high providing there is early diagnosis and treatment.

Training of Health Professionals in Skin Disease

Teaching of medical students, postgraduates, family doctors and nurses is an essential part of a dermatologist’s work.5 Although 15% of GP consultations relate to skin disease, only 5% of GP vocational training schemes contain a dermatology component; and the undergraduate curriculum contains on average only six days of dermatology. Newly appointed GPs therefore have little experience of dermatological problems.

Provision of Skin Disease Services

With the new Parliament established in July 1999, it became evident that Scotland was without the equivalent of both the All-Party Parliamentary Group on the Skin and the Action On programme on Dermatology. In short, Scotland has fallen behind England in the structures that exist to ensure the standard of service provided. Stewart Douglas, who has recently stepped down as Chairman, has been working hard and successfully to rectify this situation.

Over the last two years in Scotland, a number of significant developments have taken place. Dermatology has been identified by the National Waiting Times Unit as one of eight specialties requiring focused support to achieve the maximum waiting target for routine patients of 26 weeks by 2005. In addition, the Skin Care Campaign Scotland (SCCS) has been established with a close relationship with the Skin Care Campaign (UK). The SCCS expects to keep a watching brief on key aspects of skin care provision in Scotland. This is important, for a number of crucial issues have to be faced up to, including shortage of dermatology beds, shortage of dermatologist numbers, the need to expand the nursing role and development of nursing education and training programmes. There is no doubt that for the future the increasing amount and sophistication of dermatology care required will need to be provided by multidisciplinary teams. In this respect, the Centre for Change and Innovation (June Andrews) has plans to introduce an "Action On Dermatology" programme,6 which will encourage redesign and development of dermatology services as required at local Health Board level. Additional funding should be seen within the context of dermatology as a low cost speciality. Secondary skin care in Scotland is provided for between £2 and £3 per head of population per year.

A potential problem of health care divergence between England and Scotland relates to Consultant recruitment. It is important that the current contract discussions produce a satisfactory outcome. We already have six vacant Consultant Dermatologist posts in Scotland, representing nearly 15% of the workforce. If the new Consultant contract in England produces a more attractive proposition for Consultant candidates, there may be increased difficulty in recruitment in Scotland. Meanwhile, it seems likely that Scottish dermatology will be looking towards increased access to outpatient therapy centres in the light of reduced bed numbers, increased staff grade and GP with special interest (GPwsi) as well as development of the specialist nurse role. It is unfortunate that there is also a staffing shortage within nursing which undoubtedly will limit potential developments.

On the nursing side, Scottish dermatology nursing training is under active development with NHS Education Scotland (NES).

The key to our understanding of the state of dermatology services is the collection of accurate and relevant data on services within Scotland. It has been recognised that too little information is being routinely collected to get a clear picture of each area service. Moves are afoot to collect this to include key areas such as biopsies, patch testing, phototherapy and other specialist clinics. This, it is hoped, will in the future, be in a standardised format. Such data should provide a current picture of the spectrum of dermatology services and provide clear warning of areas requiring attention.

It is encouraging that the latest version of the SNOMED-CT clinical coding system incorporates the British Association of Dermatologists diagnostic lexicon. Electronic systems based on structured letters, which use these codes have the potential to make quantum improvements in the quality and completeness of dermatological clinical data. Current data collection in the NHS is by crude manual systems which ignore most outpatient and day patient dermatological activity.

Dermatology services in Scotland will, for the near future, be fundamentally provided through the National Health Service. While such services develop in their quality and range, equity of care throughout Scotland should be provided increasingly by teams within specialist outpatient clinics and a wide range of sub-specialty services supported by outpatient therapy centres. Increasing specialisation by nurses, primary health care training, increased consultant numbers with the necessary expansion in consultant trainees (SpRs) are our targets for the future.

References:

  1. Williams H C. Dermatology: Health Care Needs Assessment. Ed A. Stevens, J. Raftery. Radcliffe Medical Press, 1997 Harlow D, Poyner T, Finlay A Y, Dykes P J. Impaired quality of life of adults with skin disease in primary care. British Journal of Dermatology 2000; 143: :979-982 Williams H C. Increasing demand for dermatological services: how much is needed? Journal of the Royal College of Physicians, London, 1997; 31: 261-262 An Investigation Into The Adequacy Of Service Provision And Treatments For Patients With Skin Diseases In The UK. A Report of the All Party Parliamentary Group on Skin. London, March 1997. Royal College of General Practitioners and British Association of Dermatologists. Dermatology for General Practice Trainees. Royal College of General Practitioners, London, 1998.
  2. Action on Dermatology: Good Practice Guide, NHS Modernisation Agency, London, 2003.

SCOTTISH SKIN BIOLOGY CLUB

Secretary:
Dr David Greenhalgh
Department of Dermatology
University of Glasgow
Glasgow G12 8QQ
Tel: 0141-330 6914
Fax: 0141-330 4008
Email: dag6g@clinmed.gla.ac.uk

Chair:
Prof. WHI McLean PhD DSc
Wellcome Trust Senior Research Fellow
Professor of Human Genetics
Human Genetics Unit,University of Dundee
Ninewells Hospital and Medical School
Dundee DD1 9SY, UK
Tel:  +44-1382-425618
Fax: +44-1382-425619
Email: w.h.i.mclean@dundee.ac.uk

Function

The Scottish Skin Biology Club was formed in 1969 to provide a forum for discussion amongst dermatologists, scientists, and veterinary practitioners based in Scotland with a common interest in applied or basic science of skin. Originally known as the Skin Biology Club it was renamed with the addition of "Scottish" to its title in the year 2000. The members number 80-90 and come from all parts of Scotland and the north of England. They tend to be based in hospitals, universities or in other academic and commercial research organisations. The life-time joining fee is £5 and new members are always welcome.

Meetings

Meetings take place twice yearly, usually, on a Thursday in May and November. Members and guests present scientific papers in a relatively informal setting to promote as much discussion as possible. Work is often presented at a preliminary stage allowing it to be refined and developed later for publication. At many meetings a guest speaker is invited to give an overview of a particular topic of general interest to members.

Contact

Dr David Greenhalgh
Department of Dermatology
University of Glasgow
Glasgow G12 8QQ
Tel: 0141-330 6914
Fax: 0141-330 4008
Email: dag6g@clinmed.gla.ac.uk

SCOTTISH PHOTODYNAMIC THERAPY CENTRE

In January 2001, the Barbara Stewart Cancer Trust (Dunfermline) officially established the Scottish Photodynamic Therapy Centre, which is based in the Photobiology Unit, Department of Dermatology, Ninewells Hospital, Dundee.

Barbara Stewart

Barbara Stewart was diagnosed as having an inoperable adenoid cystic carcinoma of the trachea in 1993. After failure of conventional therapy she was informed that there was no more that medicine could do for her. Following reading a Daily Mail article about photodynamic therapy (PDT), she sought and received repeated PDT for her lung cancer in Goole Hospital under the care of Professor Keyvan Moghissi. Prior to her death some six years later, she and her husband then determined that they would fund a charity, the Barbara Stewart Cancer Trust, which then donated £1.7 million to establish a Scottish Centre to be fully equipped to deliver PDT for multiple types of cancer.

The Centre has three main functions:

  • the provision of effective patient treatment
  • to develop research to improve cancer diagnosis, photodynamic diagnosis (PDD) and therapy
  • the development of a national training centre for PDT

During the first year since the Service was established (January 1st 2001 - December 31 2001), a number of patients have been treated with PDT (17 with lung cancer, 8 with brain tumours, 13 with head and neck, 74 with gastrointestinal tumours (PDD and PDT), and 499 with pre or malignant skin cancers). All have received treatment in the Centre with patients attending from throughout Scotland. It is the intention of the Centre to help make PDT available in all major cities of Scotland.

If you would like further information about the Centre, please contact:

Ms Carol Goodman (PDT Centre Co-ordinator),
Professor James Ferguson, or
Dr Harry Moseley
Photobiology Unit
Ninewells Hospital and Medical School
Dundee DD1 9SY
Tel. 01382 496498
e-mail: carol.r.goodman@tuht.scot.nhs.uk

or about the Barbara Stewart Cancer Trust contact:

Barbara Stewart Scottish Laser Centre Trust for Cancer
Pitconochie House
Crossford
Dunfermline KY12 8RH
Tel. 01383 626856

e-mail: bsct.pdt@virgin.net

SCOTTISH PAEDIATRIC DERMATOLOGY SPECIALIST INTEREST GROUP

The Scottish Paediatric Dermatology Special Interest Group SPDSIG was established in 1998 by Olivia Schofield and Pamela McHenry. The aim of the group is to share clinical information, research and epidemiological data in order to provide the best possible clinical service for children with skin disease.  Membership is open to all interested consultant dermatologists, consultant paediatricians and medical genetic consultants, in addition to non career grade staff who have a commitment to paediatric dermatology.
Meetings are held on a twice yearly basis, usually on the evening prior to the autumn and annual meetings of the SDS.  Members are invited to bring details of clinical cases for discussion and speakers are invited to lecture on requested topics.

For further information or to be added to the mailing list, please contact:

RM Ross Hearn
Secretary SPDSIG
Consultant Dermatologist
Department of Dermatology & Photobiology
Ninewells Hospital and Medical School
Dundee
DD1 9SY
rosshearn@nhs.net

Catherine Jury
Chair SPDSIG
Consultant Dermatologist
Royal Hospital for Sick Children
Dalnair Street
Glasgow
G3 8SJ
catherine.jury@ggc.scot.nhs.uk

SCOTTISH MELANOMA GROUP

This multi disciplinary group was formed in 1979 by a group of interested clinicians involved in the management of patients with cutaneous malignant melanoma. The group collects data on clinical and pathological features and follow up information for melanomas removed in both NHS and private sector.

Information has now been gathered for almost 10,000 patients. The data constitutes one of the very few population-based melanoma databases in existence and is highly regarded worldwide. There have been multiple publications and several postgraduate degrees based on the information held.

The group is based on 5 regions- Highland, Grampian, Tayside, West of Scotland and SE Scotland. Each area has a local co-ordinator who acts as a focus for data collection and organization of follow-up. The database could not function without the input of the clinicians and pathologists who fill in the proformas for registration. It is vital that this continues.

A small committee including the 5 co-ordinators administers the group. Those wishing access to the data should write a request to the chairman of the group stating what information they would like and a brief description of their study. Any published or presented work must acknowledge the SMG for use of the data. A log of current and past studies using SMG data is kept and this hopefully should avoid duplication of studies in the future.

Who’s who?

Chair & SE Scotland Co-ordinator

Valerie Doherty
Consultant Dermatologist
Royal Infirmary
Edinburgh EH3 9YW
val.doherty@luht.scot.nhs.uk

Secretary and Highland Co-ordinator

James Vestey
Consultant Dermatologist
Raigmore Hospital
Inverness IV2 3UJ
James.vestey@haht.scot.nhs.uk

Grampian Co-ordinator

Marianne Nicolson
Consultant Medical Oncologist
Anchor Unit
Aberdeen Royal Infirmary
Aberdeen AB25 2ZN
m.nicolson@arh.grampian.scot.nhs.uk

Tayside Co-ordinator & Pathology Co-ordinator

Alan Evans
Consultant Pathologist
Ninewells Hospital
Dundee DD1 9SY
alan.t.evans@tuht.scot.nhs.uk

West of Scotland Co-ordinator

Prof. R M MacKie
Department of Public Health
University of Glasgow
1 Lilybank Gardens
Glasgow G12 8RZ
rmmk2w@clinmed.gla.ac.uk