"Could they not provide more flexible hours for the Isotretinoin Clinic?"

About: NHS Ayrshire & Arran

(as a parent/guardian),

My daughter was referred to the nurse led Isotretinoin clinic at Heathfield Clinic. She was started on treatment last year and had to attend the clinic every 4 weeks in order to continue treatment. Before commencing treatment, we both had to sign an agreement stating she would attend 4 weekly in order to continue treatment.

Isotretinoin is used to treat severe acne and is mainly prescribed for adolescents. The clinic takes place in the afternoon one day each week. At each clinic she has to have blood taken and a pregnancy test carried out before being seen by the nurse practitioner who will then write a prescription.

While the clinic was at Heathfield you then had to take the prescription to Ayr Hospital to have it dispensed. While the treatment has been very successful it has been made very difficult due to the inflexibility of the clinic timings. Most people attending this clinic are in full time education and many are in the process of sitting exams. The clinic hours are during the school day and there is no deviating from these times.

My daughter was sitting a pre lim on her appointment day and I was told that she would have to wait until the next week and break her treatment. The following week she also had an exam and I was informed that I had a signed a form to say she would attend every 4 weeks and I was breaking the agreement. I did indeed sign the form but was unaware of the inflexibility of the system. It is also difficult if parents are working to arrange transport from school to the clinic and back to school during working hours.

Would it not be possible to have the clinic outside of school hours or at least have some appointments available later in the day or early evening? When I suggested this to a member of staff at the clinic, she was very abrupt in her reply and said that this is what happened and we had to accept it or stop treatment.

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Response from Eunice Goodwin, Patient Feedback Manager for NHS Ayrshire and Arran, Quality Improvement and Governance Team, NHS Ayrshire and Arran

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Dear jwhite,

I am sorry the current clinic appointment system is so inflexible you were met with an abrupt response when you raised your question. In our endeavour to make our service patients centred, this is not what we want your experience to be.

Those of us who have had to live with teenagers know how difficult the teenage years are for the student and the parents, without adding this situation and prelims into the mix. It is clear that you and your daughter want to comply with the treatment and the rigidity of the service makes it difficult to do so.

It does seem that ideally a couple of things could be considered for change although they may not be practical or possible for reasons unknown to me.

• Could the clinic be held in Ayr Hospital to save the need to go to both hospitals?

• Is there a possibility that the blood and pregnancy test could be carried out prior to the clinic anywhere else?


• Could the clinic run from 4.00- 6.00 or something similar on 2 different days a month to provide a little flexibility?

I do not have any personal experience with this clinic and do not know if there is an opportunity for change, but I can certainly ask the question by passing this on to the appropriate manager.

I hope your daughter is coping well with the whole exam situation and she gets good results.

Kind regards,


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Response from Skin Conditions Campaign Scotland

At Skin Conditions Campaign Scotland, we too recognise the frustration for people where there is inflexibility in the system. We welcome the response from Eunice, the Patient Opinion Co-ordinator within NHS Ayrshire and Arran and we are pleased that efforts will be made to look at ways the service provision may become more person-centred.


Sheila Hannay

Director and Chair, Skin Conditions Campaign Scotland

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Response from Eunice Goodwin, Patient Feedback Manager for NHS Ayrshire and Arran, Quality Improvement and Governance Team, NHS Ayrshire and Arran

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Dear jwhite,

I would also wish to offer my apologies to you regarding the abrupt response you received when you raised your legitimate questions.

The Isotretinoin clinic is available on a Tuesday afternoon at Crosshouse Hospital or Wednesday afternoon at Ayr Hospital. Although a nurse led service the nursing staff require to have access to medical staff if any issues arise that they may require assistance to resolve and were set up at in consultation with the medical staff to ensure their availability. The clinic also requires the appropriately trained nursing team to include non-medical prescribing qualifications. This qualification allows nurses to write and issue prescriptions but it is not held by all nursing staff.

I appreciate that evening clinics would be helpful but as highlighted before as it would be difficult to arrange the clinic to have all the staff, particularly medical staff, available. As you are aware the dermatology department has recently moved from Heathfield Clinic to Ayr Hospital which should reduce some of the inconvenience to you (and others) as they pharmacy department is on site but it would be closed in the evening so you would be back to making two visits per month rather than one. (This is a hospital only medication).

GP practices are reluctant to carry out routine blood tests for treatments prescribed and monitored within the hospital setting. In accordance with the Pregnancy Prevention Programme and the prescribing criteria of the drug companies we must have a negative pregnancy test obtained at the clinic immediately prior to a prescription being generated.

With regards to a break in the treatment course, it is unfortunate that you were not offered the option of travelling to Crosshouse for a one off appointment as this was such a difficult time for your daughter. However, please be assured that the treatment benefits of this medication would not have been significantly reduced by a short break in treatment.

I hope this information is helpful and goes some way to addressing your concerns and points raised.



Alison Neil

Charge Nurse


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