Freedom of Information Team Dudley CCG Response by email 2nd Floor, Brierley Hill Health and Social Care Centre Venture Way Brierley Hill DY5 1RU 20 May 2016 FREEDOM OF INFORMATION ACT 2000 Dudley CCG - Intermediate/Community Dermatology Service: RFI0423 Thank you for your request received 6 May 2016. You asked for information regarding the above. Your request for information has now been considered. I will answer your queries below: 1. Do you currently commission either intermediate or community dermatology services for your population? Yes we do commission community dermatology services. 2. If so please provide a copy of the service specification for this service; Attached this is DGFT. There are a couple of very small GP providers doing this, but there specifications are largely the same as the DGFT one. 3. Please advise the name of the organisation that has been commissioned to provide this service; Dudley Group Foundation Trust Clement Road Surgery (GP based service) Lion Health Surgery (GP based service) 4. Please advise the date on which the contract is due to end. All contracts end on March 31 st 2017 but are renewed on annual basis. If you have any queries or concerns, or are dissatisfied with the handling of your request please contact the Head of Communications & Public Insight at Dudley CCG, Brierley Hill Health & Social Care Centre, Venture Way, Brierley Hill DY5 1RU. The contact telephone number is 01384 321676 or alternatively email Laura.Broster@dudleyccg.nhs.uk. Chair: Dr David Hegarty Chief Executive Officer: Mr Paul Maubach
You can also refer to the Information Commissioner at: Information Commissioner s Office Wycliffe House Water Lane Wilmslow Cheshire SK9 5AF Telephone: 01625 545700 www.informationcommissioner.gov.uk Yours sincerely Matthew Hartland Chief Operating & Finance Officer Chair: Dr David Hegarty Chief Executive Officer: Mr Paul Maubach
SCHEDULE 2 THE SERVICES A. Service Specifications Service Specification No. C02 Service Community Dermatology Service DCCG Only Commissioner Lead Mark Curran Provider Lead Keisha Dell Period 1 April 2016 31 March 2017 Date of Review December 2016 1. Population Needs 1.1 National/local context and evidence base The aim of the service is to provide a fast, safe and clinically appropriate community based dermatological service for the registered patients of the GP practices within Dudley CCG. Evidence Base The White Paper Our health, our care, our say, a new direction for community health services DoH, February 2006 emphasised the importance of service delivery as close to the user as possible. There is good evidence from the DoH to suggest that removing services traditionally delivered in secondary care settings and placing them in the community improves access, reduces demand for secondary care services and consequently reduces overall waiting times for outpatient and inpatient hospital care. 2. Outcomes 2.1 NHS Outcomes Framework Domains and Indicators Domain 1 Domain 2 Domain 3 Domain 4 Preventing people from dying prematurely Enhancing quality of life for people with long-term conditions Helping people to recover from episodes of ill-health or following injury Ensuring people have a positive experience of care Domain 5 2.2 Locally Defined Outcomes Treating and caring for people in safe environment and protecting them from avoidable harm Patients are diagnosed and treated within the community in accordance with the relevant policies Procedures of Limited Clinical Value (PLCP) and Aesthetic Surgery Policy Patients have rapid access and minimal delay to diagnosis and treatment. Patients move appropriately and seamlessly between local services Secondary care no longer receives inappropriate referrals or referrals without documented preliminary investigations. Service users feel the service is more responsive to their needs. 3. Scope 1
3.1 Aims and Objectives of Service Aims As commissioners of health services, Dudley Clinical Commissioning Group s (DCCG) aim is to commission services that are of a consistently high quality and the ensure that all services are safe, effective, personalised and fair. The aims of the Community Dermatology service are to:- Diagnose, treat and manage patients with dermatological conditions as are set out in section 3.4 of this specification. Reduce the need for patients to be seen in an acute outpatient setting Improve access to care and ensure that patients are seen and treated in an environment most appropriate for their needs. Develop an integrated Dermatology pathway across primary and secondary care, working in partnership with GPs and Consultant Dermatologists. The service is for the provision of a Consultant led service. bank holidays. The service will not operate during The service will: Provide comprehensive new patient assessments Fully inform patients of the treatment options in accordance with the PLCP and Aesthetic Surgery Policies Arrange histology on all removed lesions Develop patient management plans including follow-up treatment Provide appropriate follow up care and advice on post-operative discomfort and problems including clear advice on out of hours management. * Objectives The service aims to improve access to dermatology services through triage of referrals, shorter waiting times and rapid access to DGFT. The commissioning of this service fits with the commissioning objectives of the DCCG in that it provides care closer to home, and reduces the need for referral to acute hospital outpatients. 3.2 Service Description/Care Pathway The aims of the Community Dermatology service are to:- 3.3 Population Covered Diagnose, treat and manage patients with dermatological conditions as are set out in section 3.4. of this specification. Reduce the need for patients to be seen in an acute outpatient setting Improve access to care and ensure that patients are seen and treated in an environment most appropriate for their needs. Develop an integrated Dermatology pathway across primary and secondary care, working in partnership with GPs and Consultant Dermatologists The service is for the patients registered with Dudley CCG General Practice. 3.4 Any Acceptance Criteria and Thresholds The only source of referral to the Community Dermatology Service will be Dudley CCG GP s. The service is open to all males and females to treat benign lesions and rashes; except where they meet the exclusion criteria. All referrals must be sent to the Community Dermatology Service at Withymoor Surgery, Squires Court, Brierley Hill, DY5 3RJ, Tel: 0845 1470012 Fax: 01384 364702 using the referral forms in the appendices to this document. 2
The Community Dermatology Service is suitable for the referral of patients suffering from nonmalignant skin lesions, rashes or sub-cutaneous lesions, lumps and bumps which are not suitable for management by the Primary Care Clinician. Exclusions to the service are for patients eligible for referral via the Rapid Access Dermatology Service for skin lesions showing malignant features, housebound patients, leg ulcers warts and veruucas and facial lesions and for any procedures contained within Dudley CCGs Commissioning policies for Aesthetic Surgery and Procedures of Limited Clinical Value. All referrals will be acknowledged to the referring GP practice and all new patients to be seen within the Community Dermatology Service will receive notification of an appointment, within 48 hours (2 working days) from date of the referral and must meet the 18 week referral to treatment target. The provider of the service shall deliver assessment, investigation and treatment to patients suffering from non-malignant skin lesions, rashes and lesions which are not suitable for management by the GP as listed below. In accordance with the 18 week referral to treatment target the service will operate a one DNA per patient system prior to discharging the patient back to the referring practitioner. An example of those conditions treated within the service are set out below however, this is not an exhaustive list All suspected non-malignant skin lesions and rashes including but not limited to: Actinic Keratosis / Solar keratosis All skin rashes including hirsutism Benign Apocrine Benign Naevi/Moles Congenital Naevi Dermatofibroma Discoid eczema, xerosis, generalised pruitus Epidermoid/Pilar Cysts Giant Comedone Histiocytoma Lipomata Melasma/Cholasma Mild/moderate acne not requiring Roaccutane Mild/moderate eczema Molluscum Contagiosum Naevus Sebaceous Pyogenic Granuloma Seborrhoeic Keratosis Seborrhoeic Warts / Keratosis Solar Comedones/Giant Comedones Solar Lentigines Spider Naevi/Vascular Angiomata/Campbell de Morgan spots Tinae/fungal/recurrent bacterial infections Uricaria/angioedema Exclusion Criteria Exclusions to the service are patients eligible for referral via the Rapid Access Dermatology Service for skin lesions showing malignant features, housebound patients, leg ulcers, viral warts, 3
verrucas and facial lesions and for any procedures contained within Dudley Clinical Commissioning policies, in particular Aesthetic Surgery and Procedures of Limited Clinical Priority. 3.5 Interdependences With Other Services/Providers There are close links with referring GP practices as well as with the hospital based Dermatological Service based at Dudley Group NHS Foundation Trust. Whole System Relationships The key stakeholders include GP s referring into the service, patients, commissioners and secondary care staff, both clinical and non-clinical. It is for the provider to ensure that all clinical staff are competent and have the necessary qualifications and training necessary to practice. Within Dudley, the provider will work alongside the commissioners and the secondary care provider through the Dermatology Forum to ensure that these requirements are fulfilled. 3.6 Referral Route Service Model As per the pathway below, the service model centres on GP referrals to the community dermatologist. The service will be supported by administrators that will organise and arrange appointments, cancellations, and collect and provide the information required to monitor the service along with any other general administrative duties required. Pathways Exclusions: Patients who are eligible for referral via the Rapid Access Dermatology Service for skin lesions with malignant features; housebound patients; leg ulcers; facial lesions; and veruccas and viral warts Patient with skin condition (where self care has failed or is not appropriate) Advice on management and prescription medications Primary Care Clinician Community Dermatologist Management by Community Service Skin lesions requiring excision NHS E-Referral Histology Benign Yes No Secondary care Dermatology Service GP 3.7 Response Time and Prioritisation 4
Patients will receive treatment within the national timescales, with a maximum waiting time of 4 weeks from diagnosis to treatment. 18 week incomplete Referral to Treatment Waiting times will be monitored and reported on a monthly basis. 3.8 Discharge Criteria and Planning The provider will be responsible for ensuring that the referring GP is sent a typed summary letter outlining the diagnosis, investigations, treatment plan and patient advice following each consultation. This will be in accordance with SC11. 3.9 Self-Care and Patient and Carer Information Information on procedures and treatment options to be provided to each patient as appropriate. 3.10 Information Required by DCCG The information for the service will be collected by the administrators at Withymoor Surgery. It will be sent to the Commissioner and Information team personnel via an Excel Spreadsheet on a monthly basis using the template embedded below. DGFT will provide secretarial and nursing support for Ladies Walk clinics only. 3.11 Geographic Coverage/Boundaries SLK Dermatology Template.xls The service is for the patients registered with Dudley CCG General Practices. 3.12 Relevant Networks and Screening Programmes The provider will ensure that the clinicians providing the service maintain a personal development portfolio identifying their education requirements matched against their competencies required for the Community Dermatology Service, and how these have been met and maintained. 4. Applicable Service Standards 4.1 Applicable National Standards (e.g. NICE) Not applicable 4.2 Applicable Standards Set Out in Guidance and/or Issued by a Competent Body (e.g. Royal Colleges) Not applicable 4.3 Applicable Local Standards 18 week RTT National Standards apply. 5. Applicable Quality & Information Requirements and CQUIN Goals 6. Availability of Service 6.1 Location of Provider Premises The location of the service is: Withymoor Surgery, Squires Court, Brierley Hill, DY5 3RJ 5
Tel: 0845 1470012 Fax: 01384 364702 Ladies Walk Clinic, Priory Lane, Sedgley, Dudley DY3 3UA. 6.2 6.3 Number of Sessions Provided at each Location A total of six medical sessions per week are provided; 3 session at Withymoor Surgery and 3 sessions at Ladies Walk Clinic. The Clinical Nurse Specialist also runs one session in each location, in addition to the above. Days/Hours of Operation There are six planned medical sessions for the service per week; at Withymoor Tuesday morning (1 session), Tuesday afternoon (2 sessions); at Ladies Walk Monday morning (1 session), Monday afternoon ( 2 sessions)the Clinical Nurse Specialist also runs one session in each location: Withymoor Tuesday afternoon; Ladies Walk Wednesday afternoon (changing to Monday afternoon in 2016). Version control Version Number Date agreed Detail of Change 2 19.01.16 Agreed internally Dudley CCG no material change in service. 3 29/3/16 Amendments to specification from DGFT 4 30.03.2016 Amendments to specification from Dudley CCG 6