"Distressed about grand daughter"

About: Aberdeen Royal Infirmary / Dermatology (Skin Conditions) NHS Grampian

(as a relative),

My Grand-daughter now aged 18 months developed a skin condition around 8 months ago, August 2014. Unfortunately the condition has deteriorated to the extent there have been numerous visits to the GP which has resulted in various prescribed creams, including on one occasion a bulk supply of Herpes tube ointment, which caused great pain as you may imagine, why this was prescribed for a baby in my view needs investigation. The baby was getting into distress with really bad body sores. A request was made to the GP for urgent support by having a Dermatologist at Aberdeen Royal Infirmary view the condition. The answer to this was a referral letter would be sent, this takes weeks for a response and to our horror up to 9 months for an appointment at ARI. The GP had a view this baby's skin condition was not urgent, that needs investigation. We were so upset at this situation I offered to pay for Private care, the GP after another week had a letter delivered to Albyn Hospital, more shocks when they telephoned my Daughter in Law to say they do not see infants under 3 years of age, it was a fact that the GP did not know! In the meantime very quickly a letter was generated by NHS Grampian taking my Grand Daughter off the NHS waiting list, that was the fastest reaction we have seen!

Meanwhile this little girls skin condition deteriorated. On contacting the GP unit about this situation at Albyn Hospital there was no apology, the infant was put back on the NHS Grampian waiting list.

I made enquiries including finding this internet site, to find a serious failure of rapid Dermatology response care in NHS Grampian and in fact Scotland, the waiting times are scandalously long way beyond the political posturing time-scales.

I write this after being told that despite a further plea my little Grand-daughter will have to suffer further until a GP relents and takes appropriate steps to get a now very urgent appointment with a Dermatologist. I have told my Family about this disgraceful situation and my son to take his baby to Accident and Emergency as it seems the system here in Aberdeen is in melt down, I am distressed that a baby is treated in this manner and welcome a full investigation. No person especially a baby who cannot explain their discomfort should be treated this way. I also feel GPs and ARI should be held fully accountable for any delay tactics causing further unnecessary suffering and long term affects in health as a result of inaction.

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Responses

Response from Linda Oldroyd, Nurse Consultant Patient Safety and Experience, NHS Grampian

Dear relative

Thank you for taking the time to post this feedback. Your story is very distressing to hear. No one would want to see a child suffer from lack of appropriate care.

Following on from our telephone conversation I hope you feel that we have managed to move things forward for your Granddaughter. In terms of investigating the particular concerns you have raised about the GP care and the care from ARI/RACH I think the best way forward would be if your son or daughter-in-law was to get in touch with me. I would need to talk this over with them before looking into the particulars of the case in more detail.

In the meantime I have said I would try to find out about the policy of Albyn Hospital with regard to children under three years of age and I will contact your daughter- in- law with information when I have it.

Please get in touch with me again if you would like to speak further. I can be contacted by email at loldroyd@nhs.net or by telephone on 01224 558449.

KInd regards

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Update posted by Les1 (a relative)

Thanks for the update. Your intervention by making direct enquiries with the GP unit on Thursday is I believe responsible for my Grand Daughter being upgraded to an "urgent" appointment with Dermatology at ARI at a further emergency appointment today at the GP.

"Urgent" according to meaning of the word is, immediate or instant, however I was shocked to be told that this urgent appointment in NHS Grampian terms means a wait of possibly a further month. Further detrimental delay seems inevitable and not in our opinion acceptable.

While we are relieved at my Grand Daughters case now being moved forward I remain disappointed with care standards and the disgraceful long waiting times, the distress caused to both the patient and family is not acceptable. Urgent should mean immediate not next month.

Response from Linda Oldroyd, Nurse Consultant Patient Safety and Experience, NHS Grampian

Dear relative

NHS Grampian fully accepts that we are not currently able to meet the target waiting times for Dermatology for all of the patients referred to this service and wholeheartedly apologises for this. The Unit Operational Manager for the service has provided the following information:

I refer to your complaint which was passed to the Feedback Service NHS Grampian from the Patient Opinion website. The Unit Operational Manager has investigated the reported concerns and is very sorry that you have had cause for concern about the arrangements for your grandaughter's appointment at the Dermatology Clinic.

While we are currently making every effort to see patients at clinic within the 12 week target, due to the high number of patients being referred to the Dermatology service, this is not always possible for those referred on a non urgent basis.

We are taking a number of actions to reduce the current waiting time for patients referred to this speciality. I hope you will accept my sincere apologies for the unsatisfactory level of service that we have provided on this occasion, but trust you will be reassured that action has been taken to rectify your concerns.

I hope you find this information from the Unit Operational Manager helpful and please be assured that we aim to post additional information on increased activity within Royal Aberdeen Children's Hospital as soon as we can.

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Update posted by Les1 (a relative)

Firstly I must thank Linda Oldroyd for her kind support and actions in assisting us.

Regards the NHS Grampian Unit Managers response.

My view remains that definitions of urgent by various GPs needs investigation, they have varying skills in Dermatology. In the case I raised I fail to understand why an infant can be left with such a distressing worsening condition for so long.

We were told that ARI Dermatology was on a 9 month wait, yet we are told here that the target was 12 weeks.

I welcome the Dermatology Unit Manager publishing auditable target times achieved at this unit on this blog, best and worst whether urgent or non urgent.

Regards Albyn and other BMI Hospitals their Dermatologists will not see an infant under 3 years, I am told due to insurance costs. So we are totally dependant on the NHS, there is no alternative.

I have now left this matter in the hands of the Parents, but hope exposure of this situation helps others with distressing skin conditions. The infant is still on the waiting list for an appointment at this time.

Update posted by Les1 (a relative)

Distressed about Grand daughter.

I update the story to say my GrandDaughter has been given an appointment with Dermatology in a few weeks time. A relief to us all, we hope a solution is found.

Response from Skin Conditions Campaign Scotland

Dear relative

We are very sorry to read of your grand-daughter's situation. We appreciate that waiting for appropriate treatment has been extremely distressing for your family. It is positive that matters have moved forward and your grand-daughter will now be dealt with as an urgent referral, albeit with a further wait of up to a month. We note that NHS Grampian has offered apologies for the delay and they are working to reduce the waiting times (for dermatology).

Skin Conditions Campaign Scotland exists to campaign for improvement in treatment and care of people living with skin conditions in Scotland. Dermatology training is no longer compulsory for trainee GPs, though GPs see at least 3 people each day with a skin condition, and very few of Scotland's GPs have had specific training in skin disease. At Skin Conditions Campaign Scotland we are actively campaigning for better dermatology education at primary care level so people will receive appropriate advice at their first port of call, the GP surgery.

So we would like to thank you for telling this story on the Patient Opinion site and highlighting the experience of your grand-daughter's dermatology care so far. It is vital that people speak out about the treatment they received for skin conditions in Scotland so we raise awareness of both positive and negative aspects of care. We do hope that your grand-daughter's situation has stabilised.

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Update posted by Les1 (a relative)

Skin Conditions Campaign Scotland

Thank you for your response to my story and the informative report. I and other readers of this blog will be shocked to read your statement.

“Dermatology training is no longer compulsory for trainee GPs, though GPs see at least 3 people each day with a skin condition, and very few of Scotland's GPs have had specific training in skin disease”

In view of these revelations from “Skin Conditions Campaign Scotland” I put the following questions to both NHS Grampian and the Scottish Health Ministers Office.

1. Why is Dermatology designated as not compulsory in training for GPs in Primary Care? There is a confirmed shortage of Dermatology Consultants, trainee GPs might realise some encouragement to specialise in Dermatology.

2. What criteria and logic was applied in the actual decision process of NHS Scotland to make "Dermatology not compulsory for GP training in Scotland".

3. What did the NHS in Scotland envisage would happen to the health of Dermatology Sufferers in Scotland as a consequence of endorsing GPs trainees not requiring formal Dermatology training and existing low levels of GPs with Dermatology training?

4. Is there any legal or ethical responsibility for an NHS GP in Scotland to declare to their Patient with a Dermatology condition if he or she is not trained in Dermatology?

5. Does the GP who has this Dermatology training omission have a duty of care to refer a Dermatology Patient immediately to another GP who has the appropriate training and diagnostic skills?

6. Are GPs with no formal GP Dermatology training, regardless of this fact, permitted by NHS Scotland to both diagnose and prescribe medicines for Dermatology complaints?

7. How many Dermatology trained GPs are there in Grampian and how many in Scotland, what percentage of competence in GP Dermatology is there in both Grampian and Scotland?

Patients going to GPs for Skin Problems need this answered without delay.

My own experience recently has raised my awareness of the distress dermatology infection causes. While waiting for a Dermatology Consultants appointment, over many months, our Infant Grand-daughter was examined by a few different GPs and was prescribed various creams including, to our horror, herpes cream, thankfully this was only lightly used due to the distress it caused and it was stopped by the Parents.

At this time NHS Grampian and the Scottish Health Ministers Office have not provided explanations for earlier questions, the reasons Dermatology Care in Aberdeen has been allowed to decline in standards to waiting times of 9 months, a month at best in worst cases of illness. Why was this not flagged up years ago and dealt with by the CE and Managers at ARI?

One MP has told me this, “Unfortunately, it is well known that Grampian have a problem recruiting and retaining consultants in many areas including paediatrics, orthopaedics and others” why is the question? I back the "Skin Conditions Scotland Campaign", Public awareness of this growing distressing Health issue and serious shortage of Consultants is essential.

I hope to get some answers here!

Positive note: I am fortunate, my own Health Centre has an excellent Dermatology GP, I have been referred in the past. Training more GPs in Dermatology would help to relieve the long waiting lists.

Response from Skin Conditions Campaign Scotland

Dear relative

Thank you for your comments on our response to your story. In September 2014, the Royal College of General Practitioners told the All Party Parliamentary Group on Skin within Westminster that it recognised that dermatology training is relatively poorly represented throughout the GP training pathway, starting from medical school. This was backed up in the King's Fund report released on 30/4/15 by the British Association of Dermatology. The RCGP recognised a need for dermatology training to be enhanced throughout the doctor pathway. Indeed, the General Medical Council's proposal to introduce a National Licensing Examination for new doctors may present an opportunity to ensure dermatology is appropriately represented in medical school curricula. We agree with you that rapid access to appropriate dermatology care is vital and note that NHS Grampian has apologised for your granddaughter's experience and has advised it is working to resolve waiting times.

Once again, thank you for speaking out and telling your granddaughter's story. We also welcome your backing for the work of Skin Conditions Campaign Scotland to improve treatment and care for people with skin conditions in Scotland. We can be contacted via info@skinconditionscampaignscotland.org.

Sheila Hannay

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Update posted by Les1 (a relative)

I thank Skin Conditions Campaign Scotland for their second informative response.

We are very fortunate that Charitable Organisations such as SCCS work so hard for Patients with Health conditions. Without these Charitable Organsisations and their hard working fund raising volunteers and carers our NHS would surely collapse.

My update.

I contacted the Scottish Health Ministers office on the 15th April 2015 regards our situation with unacceptable long waiting times for Dermatology in Aberdeen, I copied my concerns to NHS Grampian asking for a response. I then forward a copy of the questions posted here in Patient Opinion on the 23rd of April 2015 in direct e-mails to the same Scottish Government and NHS Officials I have made contact with.

It is now the 3rd of May 2015 and neither the Scottish Governments Health Ministers Department or the NHS have responded to my concerns. It is not acceptable that this delay happens, apathy sets in and eventually some complainants just give up. I do not intend giving up.

I will update when a response from Scottish Government and NHS is delivered.

Response from Craig White, Divisional Clinical Lead, Directorate of Health Quality and Strategy, Scottish Government

picture of Craig White

Dear Les1

I would like to thank you for taking the time to outline your understandable concerns and distressing experience in respect of your granddaugther. You have raised several important questions in respect of the issues raised by your observations and experience - I wanted to let you know that I have now taken a personal interest in this and in particular that you receive answers to the questions posed. I have spoken with colleagues within Scottish Government to seek assurances that your questions are receiving the attention that they deserve. I have been advised that a response requires contact and co-ordination to be made across a range of policy teams. These contacts have been made and I have asked that my interest in the answers and a prioritised response is made if possible. I have also sought and received assurances that NHS Grampian senior management are giving the matters raised their attention.

Thank you again for raising these important issues. I will monitor the situation closely and in the meantime offer my email address if there is anything further we can do to provide support or guidance - Craig.White@scotland.gsi.gov.uk

Best regards,

Professor Craig A White

Clinical Lead, Healthcare Quality and Strategy Directorate

Scottish Government Health and Social Care Directorates

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Update posted by Les1 (a relative)

Dear Professor White,

Thank you for your personal intervention and commitment to get my seven questions answered. It will be interesting to read the response from both NHS Grampian and the Scottish Health Departments Office.

I have a friend who is a retired GP, Chief Medical Officer (now 80) and he did not believe me when I told him that Dematology training was not required for GPs in Scotland.

I referred him to the "Skin Conditions Campaign Scotland quotes". "Fewer than 200 of the 4960 GPs in Scotland are trained in Dermatology, each year more than 1 million people in Scotland consult their GP about skin disease, almost one quarter of GP consultations".

This retired GP immediately voiced the same concerns about competency of diagnosis and prescribing when non Dermatology trained GPs are reviewing Patients with Skin Conditions. It is very worrying that patients are being examined by GPs with accepted omissions in Dermatology training. With the increases in Eczema and Skin Cancer nationwide should surely Dermatology should be an essential not optional element in GP training.

Another question we discussed was, "are there any other branches of Medicine that GPs no longer need to study"? Patients have a right to know.

Readers with concerns about Dermatology will find this link interesting,

http://www.skinconditionscampaignscotland.org

Response from Craig White, Divisional Clinical Lead, Directorate of Health Quality and Strategy, Scottish Government

picture of Craig White

Dear Les1,

I have now had the chance to consider your questions and the background information provided by colleagues - as well as completing some research of my own on the concerns about the training of GPs in respect of care of people with skin problems. The curriculum defined by the Royal College of General Practitioners, which outlines the skills required to practise medicine as a general practitioner in the NHS (last revised in May 2014) includes a comprehensive summary of the competencies required by a GP in relation to the management of skin problems. These are competencies that have to be demonstrated by medical practitioners before they are issued with a Certificate of Completion of Training, which is a requirement for them to be accepted onto the General Medical Council's GP register. This is available at http://www.rcgp.org.uk/~/media/Files/GP-training-and-exams/Curriculum-2012/RCGP-Curriculum-3-21-Skin-Problems.ashx

I note the content of the webpage of the Skin Conditions Campaign Scotland which suggests that Dermatology is no longer compulsory for trainee GPs and that GPs in Scotland have not "had proper training". Given the position outlined by the Royal College of General Practitioners and the comprehensive details of the knowledge and skill that need to be demonstrated in this area, it would be helpful if colleagues at the Skin Conditions Campaign Scotland could provide some more information on the source of their concerns, which appears to be at odds with the details that I have outlined.

In summary, the answer to the questions you listed is that the management of dermatological training is a compulsory part of the training requirements of GPs. I hope that this clarification is helpful - I will of course be pleased to review any information that the Skin Conditions Campaign Scotland have in the interests to addressing the understandable concerns that you have about what is noted on their website.

I hope that this background is helpful and thank you again for using Patient Opinion to pose these questions arising from your family's experience of accessing care for your granddaughter. If there is any element of my reply that is not helpful, please let me know and I will do my best to address this a further response.

I will make my colleagues who have policy responsibility for issues pertaining to GP training and also the management of skin conditions aware of our communications and let you know of anything further by way of detail that we may be able to provide by way of information.

Best wishes,

Craig White

Professor Craig A White

Divisional Clinical Lead, Healthcare Quality and Strategy Directorate

Scottish Government

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Update posted by Les1 (a relative)

Dear Professor White,

I am very disappointed that the seven questions I asked are not answered individually in your response. This action would make easy reading for all readers, nearly 500 of them and rising every day.

It always seems that a disproportionate amount of dialogue in response to complaints or criticism of the NHS is re-directed at substantiation of what the Public perceive as poor standards of NHS care. Most of these reported concerns of the users are auditable and real.

Why are we expected to wait up to 9 months to see a Dermatologist in Grampian?

Pay £250 privately and you see a Specialist in a few weeks, surely this is not acceptable. That fee only applies to infants over three years of age! Under three years old? Sorry you have to wait for an NHS appointment, or go to Edinburgh. I feel that is totally unacceptable.

Why is an infant of barely a year old prescribed herpes cream for an unknown body skin complaint, bleeding back and shoulder sores, application causing distress? You report we have qualified Dermatology trained GPs, approved by the Scottish Government.

Answer to this question regards a complaint about a prescription you may find wrong, NHS Grampian refer you to the Scottish Ombudsman!

What a waste of time that would be, another gobbledegook letter, wasted resources that could be diverted to actual health care. We are awash with departments dealing with complaints, experts with theories, and so short of those at the sharp end, the actual hands on Health Professionals.

Regards the Skin Conditions Campaign Scotland, I have sent correspondence including an e-mail I received from the Person Centred Team, Scottish Government Health Care Quality, Strategic Directorate, an e-mail content for consideration by SCCS Directors, I have intimated that there are evidently serious discrepancies with claims on the SCCS website which the Scottish Government your report appears to dispute.

What is surely very obvious and needs action now is that Dermatology Clinics in Scotland are under enormous pressure to provide service, they need more Staff, not waffle.

Response from Craig White, Divisional Clinical Lead, Directorate of Health Quality and Strategy, Scottish Government

picture of Craig White

Dear Les1

Many thanks for your response. I am sorry that my attempt to provide you with information on the training requirements for GPs in Scotland was not helpful. I have listed responses to your questions below:

1. Why is Dermatology designated as not compulsory in training for GPs in Primary Care? There is a confirmed shortage of Dermatology Consultants, trainee GPs might realise some encouragement to specialise in Dermatology.

Training in the management of dermatological conditions is a mandatory part of the required training and competency assessment of any medical practitioner seeking registration/qualification as a GP.

2. What criteria and logic was applied in the actual decision process of NHS Scotland to make "Dermatology not compulsory for GP training in Scotland".

There was no such decision that I am aware of as the mandatory elements of training of a GP in respect of Dermatology are as outlined in my response to Question 1.

3. What did the NHS in Scotland envisage would happen to the health of Dermatology Sufferers in Scotland as a consequence of endorsing GPs trainees not requiring formal Dermatology training and existing low levels of GPs with Dermatology training?

NHSScotland did not endorse an arrangement for GPs not to require training in Dermatology.

4. Is there any legal or ethical responsibility for an NHS GP in Scotland to declare to their Patient with a Dermatology condition if he or she is not trained in Dermatology?

All medical practitioners on the GP register of the General Medical Council will have demonstrated their competencies in the management of skin conditions as part of their training.

5. Does the GP who has this Dermatology training omission have a duty of care to refer a Dermatology Patient immediately to another GP who has the appropriate training and diagnostic skills?

All GPs are subject to the requirements of competency assessment and evidence in respect of the management of skin conditions.

6. Are GPs with no formal GP Dermatology training, regardless of this fact, permitted by NHS Scotland to both diagnose and prescribe medicines for Dermatology complaints?

All GPs who are subject to the RCGP curriculum and GMC registration requirements have training in the assessment and management of skin conditions.

7. How many Dermatology trained GPs are there in Grampian and how many in Scotland, what percentage of competence in GP Dermatology is there in both Grampian and Scotland?

All GPs have training in the management of skin conditions as part of their post-qualification training before registration on the GP register of the GMC register.

In respect of your question, "Why are we expected to wait up to 9 months to see a Dermatologist in Grampian?" I noted that in their earlier posting on Patient Opinion in April that they stated that "NHS Grampian fully accepts that we are not currently able to meet the target waiting times for Dermatology for all of the patients referred to this service and wholeheartedly apologises for this." and that " While we are currently making every effort to see patients at clinic within the 12 week target, due to the high number of patients being referred to the Dermatology service, this is not always possible for those referred on a non urgent basis. We are taking a number of actions to reduce the current waiting time for patients referred to this speciality. I hope you will accept my sincere apologies for the unsatisfactory level of service that we have provided on this occasion, but trust you will be reassured that action has been taken to rectify your concerns." It seems from this that they recognise and agree with you that the situation you described in unacceptable and are prioritising efforts to improve matters?

Thank you for sending the correspondence and email from the Person-Centred Team (who are one of the teams within my Division here at Scottish Government) to the Skin Conditions Campaign Scotland - as I mentioned in my earlier posting, this will be very helpful in deterring the source of the information on their website and enabling us to make further enquiries if this suggests the information we have is incorrect.

I hope that this response is not experienced as 'waffle' as I am genuinely trying to be as clear as I can in responding to your questions, which we are very grateful to you for raising. I would also wanted to underline and emphasise the apology that NHS Grampian offered in relation to access to specialist dermatological opinion.

One of the features of Patient Opinion that is so helpful is the one you referred to, that it allows others to read responses. I would encourage anyone reading this who has similar concerns or negative experiences about the issues outlined to use Patient Opinion to let the relevant care provider/NHS Board know about this. I have asked that the Chair of the Royal College of General Practitioners in Scotland be made aware of our communications and will make sure that I update on any further details that I receive in due course.

Thank you for your prompt feedback. I am sorry that my earlier attempt to provide a response was experienced as unhelpful - my intention is the opposite and I would be grateful for any suggestions of what further action/information I can provide to be more helpful and supportive.

Best wishes,

Craig W

Professor Craig A White

Divisional Clinical Lead, Healthcare Quality and Strategy Directorate

Scottish Government

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Update posted by Les1 (a relative)

Dear Professor White,

I thank you for this response, the content requires urgent comment from Skin Conditions Campaign Scotland, the statistics they quote, which you dispute, are the source of my most serious concerns.

It does not alter the fact that we have now reached a situation where patients may have to wait almost a year to see a Dermatologist. Surely the Healthcare and Quality and Strategy Directorate must take some responsibility. Why was this shocking waiting list allowed to happen in the first instance and what immediate action are they taking to resolve the situation?

If our GPs are all equally competent and qualified in Dermatology, why was a baby prescribed herpes ointment for raging eczema? Is that appropriate?

Why did it take numerous GP visits and about Six months to see a Dermatologist? If I had not raised this issue on Patient Opinion, we would still be waiting.....

I request that Skin Condition Campaign Scotland responds on this site, we need the GP facts to be clarified.

Response from Skin Conditions Campaign Scotland

Dear Professor White

We note your response to the relative who is 'distressed about his grand-daughter'. You ask Skin Conditions Campaign Scotland to provide some more information on our concerns about GP training. We would draw your attention to the independent report by the King's Fund into dermatology (commissioned by the British Association of Dermatologists, published at the end of April 2015) that 'has identified staff shortages, poor training, inconsistent quality in diagnosis and treatment and large variations in access to specialist care, affecting millions of patients across the UK each year'.

You outline the current process and competencies for GP training in dermatology. You do not mention that currently undergraduate training in dermatology averages two weeks at most and GP courses only provide 6 days of dermatology training. The recent King's Fund report states GP training is 'variable in terms of quality as well as syllabus, and it is not compulsory'. Yet, across the UK, 54% of the population are affected by a skin disease each year and 13 million GP appointments are made each year for skin conditions. When people present at their GP surgery with a new problem, a skin condition is the most common reason.

It is evident that many of the GPs managing this workload have received little training in dermatology and, as we have previously stated The Royal College of General Practitioners recognises a need for dermatology training to be enhanced throughout the doctor pathway. Furthermore, the President of the British Association of Dermatologists said in a press statement released on May 7th, 'it is widely acknowledged that there is a lack of knowledge about skin disease in general practice as a result of poor undergraduate and postgraduate teaching which leaves most GPs lacking the skills to manage dermatology and results in more patients being referred to Consultants. This is not the fault of the GPs but of the education they are offered.'

There is an urgent need to improve dermatology training for health care professionals within primary care. At Skin Conditions Campaign Scotland, we exist to work for the improvement in treatment and care for people in Scotland with skin conditions. The lived experiences of our patient organisation members indicates their desire for improved dermatology education within primary care where they have shared with us their experience of inconsistent quality in diagnosis and treatment. We would be happy to meet with you and your team within the Healthcare Quality and Strategy Directorate to share the patient perspective on this matter. People in Scotland with skin conditions want and need effective dermatology treatment and care that is person-centred and timely.

We may be contacted via info@skinconditionscampaignscotland.org.

Best wishes

Sheila Hannay

Director

Skin Conditions Campaign Scotland

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Update posted by Les1 (a relative)

Dear Sheila Hannay,

Thank you for a very informative response. It raises serious questions that need answers.

I am shocked that Skin Conditions Campaign Scotland have these dreadful Dermatology Training Statistics at hand. It is reasonable to assume that these statistics are available for the Healthcare Quality and Strategic Directorate. Why were they not published when I repeated my questions?

I have been writing on this blog to expose the serious lack of Dermatology Care in Grampian. I have also questioned the standards of Dermatology training GPs receive.

The feedback up until now has been predictable, difficult to absorb.

But not anymore, the precise statistics from Skin Condition Campaign Scotland has opened up debate and it needs HQSD answers

Apologies do not replace the Healthcare we all need. Why should any person with disease, unless they have the money to pay, be expected to wait up to a year to see an appropriate NHS Consultant? Also the GPs in primary care might not have the knowledge to deal with the condition as it develops while waiting, that is very worrying.

I have just read another persons story, published on Patient Opinion under name of "Fed Up Waiting" on 14th May, about Aberdeen Royal Infirmary Dermatology waiting times, this person has waited 8 months and has been told its a year wait now!

I await Professor Whites reply to Sheila Hannay's response above.

Response from Craig White, Divisional Clinical Lead, Directorate of Health Quality and Strategy, Scottish Government

picture of Craig White

Dear Sheila

Many thanks for your email. I have read the Kings Fund report (http://www.bad.org.uk/shared/get-file.ashx?id=2347&itemtype=document) which has some useful proposals to support continuous improvement of the quality of care provided for people with skin disease. The document mentions the higher rate of Dermatologists in Scotland, which prompted me to check current data on the numbers of Consultant Dermatologists working within NHSScotland. I noted that there as 7.1% increase in hospital dermatology staff in Scotland between December 2013 and 2014 (see https://isdscotland.scot.nhs.uk/Health-Topics/Workforce/Publications/2015-03-03/HCHS_by_specialty_D2014.xls).

In reference to the statement about GP training, the Kings Fund report references a presentation from the UK Parliament All Party Parliamentary Group on Skin from 11 years ago (see http://www.appgs.co.uk/wp-content/uploads/2012/06/DERMATOLOGICAL-TRAINING-FOR-HEALTH-PROFESSIONALS-2004.pdf). My understanding is that the Royal College of General Practitioners curriculum requirements referenced in my prior postings are developments that post date these concerns? Is this correct?

I completely agree with you in respect of the importance of hearing the experiences and suggestions of people with direct experiences of life with a skin condition. I will ask someone from the relevant policy team to make contact with you in order that further discussions can be arranged about this.

Meantime I will also ask the Chief Medical Officer's Specialty Advisor for Dermatology for a view on the concerns raised and also pass the further comments to the Royal College of General Practitioners Chair in Scotland.

Someone from our Division will be in touch by the end of this week to discuss how best to make arrangements to meet,

Best wishes

Craig White

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Response from Craig White, Divisional Clinical Lead, Directorate of Health Quality and Strategy, Scottish Government

picture of Craig White

Dear Les1

You will see my response to Sheila Hannay above but I also note some outstanding questions you have:

If our GPs are all equally competent and qualified in Dermatology, why was a baby prescribed herpes ointment for raging eczema? Is that appropriate?

Why did it take numerous GP visits and about Six months to see a Dermatologist? If I had not raised this issue on Patient Opinion, we would still be waiting.....

I would hope that NHS Grampian will consider these as part of their complaint investigation and that you are aware of the outcome of these now.

I’d welcome your participation in the meeting arranged with SCCS if that’s possible for you. Thanks again for raising this issue and we will be in contact with information about any improvements we plan.

Best wishes

Craig White

Professor Craig A White

Divisional Clinical Lead, Scottish Government

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Update posted by Les1 (a relative)

Dear Professor White,

Last Post I think as long as it is approved for publishing.

NHS Grampian Officials are logged as readers of this story. I suspect they would require my son to re-open dialogue again re drugs prescribed, herpes creams.

The statistic you quote of a 7.1% increase (of non defined figure) in hospital staff in dermatology in Scotland for 2013 -14 sounds good but there is up to a 12 month waiting time to see a Dermatology Consultant in Aberdeen. This situation remains a disgrace regardless of statistics and needs active support to improve.

Patient Opinion have advised me that this site was for personal experience comment and it is now discussing a policy matter, in other words it has run its course. I agree that we have exhausted the complaint.

The NHS is damaged in the Publics eyes by churning out waiting time statistics that do not match patients experiences. Health Officials and users of their services should be working together, sadly it seems difficult and sometimes confrontational when you complain. Bamboozled by facts and figures most patients give up complaining, this is to the detriment of the service.

Thanks to all readers and responders.

Response from Craig White, Divisional Clinical Lead, Directorate of Health Quality and Strategy, Scottish Government

picture of Craig White

Dear Les1

Many thanks. I agree the focus must be on improvement - including the work that is focused on an improved approach to resolution and response to complaints. You are so right about the important of people working together to support learning and change.

You have made an important contribution through your posting on Patient Opinion. I would very much like to keep in touch to update you on how the issues you have raised will continue to inform discussion. Colleagues in the Clinical Priorities Team here will be arranging a meeting with the Skin Conditions Campaign Scotland. If you would find ongoing contact on these issues helpful, please email me at craig.white@scotland.gsi.gov.uk

Thank you again for making a positive contribution through Patient Opinion,

Best wishes,

Craig W

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Response from Skin Conditions Campaign Scotland

We note the posts from Professor White and the 'final post' from Les1. We further note Patient Opinion's request that this matter should now move 'off line' as the discussion has moved into policy matters rather than patient experience. For balance, we have requested that this 'final update' is posted from Skin Conditions Campaign Scotland. We have emailed today responding to the further questions addressed to SCCS by Professor White and we have provided additional background detail on our concerns. We welcome the opportunity to meet with Professor White and his team to share the patient perspective in relation to lived experience of dermatology treatment within primary care and issues of access and waiting times for hospital based dermatology. We do hope Les1 will be free to join us at this meeting. We may be contacted via info@skinconditionscampaignscotland.org.

Sheila Hannay, Director

Skin Conditions Campaign Scotland

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