Written evidence submitted by the British Association of Dermatologists (RTR0066)


The British Association of Dermatologists (BAD) is a charity whose objectives are the practice, teaching, training and research of Dermatology. It works with the Department of Health, NHS England & Improvement, NHS Digital, NHSX, CQC, patient bodies and commissioners across the UK, advising on best practice and the provision of Dermatology services across all service settings. We also collaborate with GMC, the statutory health boards, medical schools and multi-professional Royal Societies to promote and implement training standards across the entire healthcare work force It is a membership organisation representing greater than 95% of consultant dermatologists in the UK.


The Dermatology GIRFT report (published 9th Sept 2021) highlighted the severe workforce shortages in dermatology due to long term restriction on training numbers. Dermatology training is highly competitive with many applicants applying for each training post. The English data from the GIRFT report shows that there were just 508 (WTE) dermatology consultants and 159 (WTE) vacancies. This is reflected in the data collected by the RCP on workforce and obtained in 2019 by the All Party Parliamentary Group on Skin via Freedom of Information requests to NHS Trusts in England, showing a dearth of Dermatology Consultants over large geographic areas. Even Trusts in major cities, including London, are unable to fully recruit Consultant Dermatologists. http://www.appgs.co.uk/publication/view/2019-audit-of-uk-dermatology-coverage/


It is essential that shortages in the dermatology medical workforce are addressed if we are to provide equal access to quality dermatology care.


The GIRFT dermatology national report highlights that,


‘....shortages in the dermatology medical workforce are having a serious impact on the efficient functioning of nearly all units. This was the most important problem raised by managers and consultants, meaning discussions about resolving workforce problems dominated all but a handful of visits. Workforce shortages are a key factor in the increasing use of high-cost locums and other short-term initiatives in an attempt to control waiting lists. Around a third of units have very serious staffing shortages, with some closed to routine dermatology referrals and only providing an urgent skin cancer service. In some areas of southern England, where neighbouring units have partially or fully closed, there is very limited access to NHS consultant dermatologists.


We would like to highlight a few key points:


          Workforce shortages has resulted in inequitable access to good care and delays in diagnosis with significant impact on quality of life for patients with skin disease of all ages. Shortages affect all areas, but are particularly severe in district general hospital secondary care sites, which in turn puts increased burden of work on large tertiary centres, who already struggle to meet service and training needs.


          Skin cancers are the UK’s most common cancer with around 240 000 cases in England per year, many of whom are now waiting over a year for treatment as a result of the pandemic on top of chronic workforce shortages. Data from 2018-19 show that dermatology delivers more two-week-wait (2ww) suspected cancer referrals than any other specialty. Suspected skin cancer referrals account for 21% of all 2ww suspected cancer referrals. Dermatology delivers almost all of these consultations, with plastic surgeons seeing the rest https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2019/07/Cancer-Waiting-Times-Annual-Report-201819-Final-1.pdf.  2ww referrals for skin cancer have doubled from 2012 to 2019, https://www.england.nhs.uk/statistics/statistical-work-areas/%20cancer-waiting-times/


          The burden of skin disease is significant, representing 23% of the presentations to primary care. Dermatologists deal with eczema which is the commonest disease affecting the population in infants and acne which is the commonest disease in adolescents. 


          The referrals to secondary care services continue to grow in number and complexity, year-on-year. This is due to patient demographics, ageing population, increasing numbers of skin cancer and the increasing use of systemic therapies which require careful monitoring. These increasing referrals results in many UK hospitals now failing to meet targets or resulting in reallocation of priorities so that people with severe skin disease are commonly (even before Covid) waiting many months to see a dermatologist.


          An increasing gap for the consultant workload is time to deliver education and training not only for the NTN Specialist Registrars but also for medical students, junior doctors, GPwERS, GPs, nurses, ACPs, PAs, Pharmacists etc. An audit in 2019 performed by the BAD reported that 95% of consultants supervise, teach and train on a daily basis, providing leadership, and educational and clinical governance in order to support and develop heterogenous service teams. 86% of Dermatology Consultants supervise and train nurses. The need to educate and train is likely to increase, and a critical mass of specialists needs to be maintained to deliver service as well as training.


          There is more part time working and portfolio careers in the workforce which requires more people to be trained to keep the same number of whole time equivalents. The covid-19 pandemic also threatens to increase the number of doctors leaving the profession and retiring early due to burnout, stress and retirement driven by the e.g. pensions legislation/cap.


What are the main steps that must be taken to recruit the extra staff that are needed across the health and social care sectors in the short, medium and long-term?



What is the best way to ensure that current plans for recruitment, training and retention are able to adapt as models for providing future care change?



What is the correct balance between domestic and international recruitment of health and social care workers in the short, medium and long term?



What can the Government do to make it easier for staff to be recruited from countries from which it is ethically acceptable to recruit, with trusted training programmes?



What changes could be made to the initial and ongoing training of staff in the health and social care sectors in order to help increase the number of staff working in these sectors? In particular:


To what extent is there an adequate system for determining how many doctors, nurses and allied health professionals should be trained to meet long-term need?


Do the curriculums for training doctors, nurses, and allied health professionals need updating to ensure that staff have the right mix of skills?


Could the training period for doctors be reduced?


Should the cap on the number of medical places offered to international and domestic students be removed?


What are the principal factors driving staff to leave the health and social care sectors and what could be done to address them?



Are there specific roles, and/or geographical locations, where recruitment and retention are a particular problem and what could be done to address this?



What should be in the next iteration of the NHS People Plan, and a people plan for the social care sector, to address the recruitment, training and retention of staff?



To what extent are the contractual and employment models used in the health and social care sectors fit for the purpose of attracting, training, and retaining the right numbers of staff with the right skills?



What is the role of integrated care systems in ensuring that local health and care organisations attract and retain staff with the right mix of skills?




January 2022