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GPs go forth

GP skin care targets labelled 'unworkable'

Government demands to shift even more dermatology work into the community were criticised last week as out of touch and unworkable.

The authors of a new study said the Government should stop meddling and allow already redesigned dermatology services to gain some stability. Other experts warned shifting more work to GPs would further undermine hospital departments.

The study found dermatology recommendations in the Our Health, Our Care, Our Say white paper, which include target referral rates to secondary care of just 2.9 per 1,000 population and more provision of care closer to home, were not informed by real-world GP experience.

Of 57 hospital dermatology departments questioned in the study, 72% were already providing care in the community, with 68% linked to GPSIs. However, despite this relatively comprehensive provision, referral rates varied between 10 and 22 per 1,000.

Study leader Dr Julia Schofield, a consultant dermatologist at West Hertfordshire Hospitals NHS Trust and member of the Department of Health Care Closer to Home group, said: 'The white paper is frustrating for us because dermatology is already a significantly redesigned service and we are providing care closer to home. We're already delivering, so now we're asking the Government to please just let us continue.'

GP experts warned of the dangers of a further work shift.

Dr Stephen Hayes, a GPSI in dermatology in Bitterne, Southampton, said: 'These top-down, arbitrary figures from the Government about moving care from hospitals to communities without thinking it through risk destabilising the hospitals – a bit like cutting off the branch you're sitting on.'

The same authors published a second paper, like the first in the current British Journal of Dermatology, finding white paper recommendations on new to follow-up ratios for secondary care dermatology of 1:1.53 were 'difficult to achieve' if quality care was to be maintained.

Dr Peter Stott, a GPSI in dermatology in Tadworth, Surrey, said: 'The policy makers are in their ivory tower and they don't understand what's happening on the ground. An awful lot has been achieved in community dermatology – a new pattern of care for long-term conditions is the key and the Government is still unaware of this.

Dermatology in numbers

Current referral rates to secondary care for dermatology per 1,000 population
Government target for referral rates per 1,000 population
Current new to follow-up rates in secondary care
Government target

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