Dentistry, Dermatology, what’s next?

I was the first born and studied Dentistry, my brother born 4 years later became a Dermatologist. I have wondered if there had been any more children they would have had to take up Endocrinology and ENT to keep the alphabetical order.

So I have had more than a passing interest in “Skins” and have listened to Jon’s stories of the attacks on this vital but overlooked area of medicine with disbelief. In this piece in Monday’s Guardian, “It took my patient six years to see me – a dermatologist”, the state of this particular piece of the NHS is spelled out. There is also a link to a “day-in-the-life” companion piece.

I am no great campaigner for the NHS, I think in many areas it is a spent, inappropriate, force. I feel that the repeated lies told over the past 36 years since Margaret Thatcher first coined the phrase “The NHS is safe in our hands” have only misled the population who would understandably prefer not to consider the alternative to the English religion.

Here’s the article:

It took my patient six years to see me – a dermatologist

Dermatology is a microcosm of the challenges facing the health service. It has reached crisis point

Why am I writing about dermatology? Surely the well-publicised crises in emergency medicine and general practice deserve these column inches. Dermatology is a small specialty where a slightly strange group of doctors choose to dedicate their careers to the treatment of rashes. Yet, dermatology is a microcosm of the challenges facing the NHS; like mental health and sexual health it is a specialty that has suffered progressively through NHS reforms and has now reached crisis point.

Imagine you have a rash or a growth on your skin and your GP does not know what it is or how to treat it. It may be scary – is it a skin cancer? It may be itchy, sore, bleeding, painful or looks awful. You are not alone, you are one of the 13 million people who consulted their GP last year about a skin problem and now you are one of the 750,000 referred on to see a dermatologist. These are big numbers, skin disease is common and the impact of skin disease is similar to epilepsy and chronic kidney disease.

It is clear that you need to see a consultant dermatologist, the one specialist who has the experience and expertise to help you. One quick trip to your local hospital and you will be sorted, or so the government would like you to think. In reality this is the start of battle. Firstly your referral will be triaged, another GP or nurse will read your referral and decide if you really need that appointment, many referrals are simply rejected at this point. If you pass through this then you are likely to be redirected to a privately run community dermatology service. These services, run by international healthcare corporations, employ nurse specialists and GPs with an “interest” in dermatology to see you for the cheapest possible price. In some cases they do little more than take a photograph and send this to a specialist for an opinion. It is only once you have gone through this process that you can, if you are lucky, join the waiting list to see a consultant dermatologist. In England you will wait four or five months, in Wales waits of two years are not uncommon.

A few weeks ago I saw a lady whose life had been ruined by constant episodes of swelling of her face leaving her looking like a victim of a serious assault. Her GP had correctly diagnosed angioedema but did not know the cause or how to treat it. It took her six years to navigate through triage centres and community clinics before seeing me. I quickly identified that her blood pressure medicines was causing the problem and by stopping this tablet her symptoms resolved overnight. She was extremely grateful, yet could not believe the journey she had suffered through to see me.

Government reforms have decimated dermatology leaving only 650 consultants covering the whole of the UK. Skin cancer is the commonest cancer in humans and the rates of skin cancer are increasing at a staggering 8% year on year. Dermatologists simply cannot cope with the volume of work and many smaller departments have closed, recently even the large university hospital department in Nottingham has all but shut its doors.

Across the country there are examples of departments restricting referrals or even closing to new referrals. The government promises choice, yet if you choose to see one of the nationally renowned skin cancer dermatologists at University hospitals Birmingham you better hope that you have a south Birmingham postcode as if you don’t then they will not see you. A pattern of referral restrictions being repeated across the country.

There is now a growing acceptance that in many parts of the UK it is all but impossible to see a consultant dermatologist in the NHS. With a government limiting NHS investment to headline grabbing acute specialities, how long before the rest of the NHS follows in dermatology’s footprints?

and also worth a read: The dermatologist: shipping us out of hospitals would be a grave mistake

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