Dermatology Referral and Management pathways
Scottish Dermatology Websites
Scottish Health-Related Sites
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.
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.
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.
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 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.
Dr David Greenhalgh
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.
The Centre has three main functions:
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),
or about the Barbara Stewart Cancer Trust contact:
Barbara Stewart Scottish Laser Centre Trust for Cancer
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
For further information or to be added to the mailing list, please contact:
RM Ross Hearn
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.
Chair & SE Scotland Co-ordinator
Secretary and Highland Co-ordinator
Tayside Co-ordinator & Pathology Co-ordinator
West of Scotland Co-ordinator
Prof. R M MacKie