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79 Wh|teha||
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1 +44 (0)20 7210 S1S1-4
I +44 (0)20 7210 S407
sa||y.dav|esQdh.gs|.gov.uk
www.dh.gov.uk


Our reference: SCDflsm

7 October 2013


!an Cumming
Chief Executive
Health Education England
1st Floor Blenheim House
Duncombe Street
Leeds LS1 +PL



Dear !an

! run a series of science and policy workshops and ! write as a follow-up to the latest on
Dermatology. There were 18 Dermatologists and scientists in the room for three hours
and ! was left horrified by how this is a profession in real crisis.

Skin conditions result in 13 million consultations a year in general practice and are
therefore the most common problems seen. !f we really wanted to get this right we
would probably have 6,000 consultants (roughly equivalent pro rata to Germany, France,
!taly and the USA) rather than the present 68+ (+71 WTE) and 197 funded substantive
vacancies, of which 10+ are filled by locums, at least half of whom are long term (>6f12)
and two thirds of whom do not have a CCT or CESR in the specialty.

The referrals rise every year. Demographics contribute to this as well as chronic photo
damage (a truly long-term condition if ever there was one) resulting in significant year-on-
year increases of skin cancers (not just melanomas) and, of course, patient expectations
continue to rise.

While privatisation can result in different service models, ! was given examples of how
demotivated consultants have left, so accreditation for training was lost as a result of
destruction of core specialist teams, including nurses. !t is quite clear that as a system
while super-specialist commissioning may get it right, more general commissioning has a
problem.

Over and above this, we have the impact of a particularly high level of feminisation of the
profession of Dermatology as compared with many specialist areas and the later
consequences of this. These, as you will know, include increased part-time working and
decreased mobility for jobs. This, along with increased lifefwork choices of men does
mean we probably need to increase the numbers trained particularly in this specialism.




!"#$ &'( )'*(+ ,(-*./0 1++*.("2
3"#+(44#" 5/$( 6/007 ) 5/8*(4
k|chmond nouse
79 Wh|teha||
London
SW1A 2NS
1 +44 (0)20 7210 S1S1-4
I +44 (0)20 7210 S407
sa||y.dav|esQdh.gs|.gov.uk
www.dh.gov.uk


Telecare will have a role to play and multidisciplinary teams involving specialist nurses,
technicians and pathologists will be central. There was also clear recognition of the
massive psychological needs of this patient population.

Ny reason for laying this out to you is because it is abundantly clear to me that with next
to no or no Dermatology training now at undergraduate level, and very little in general
postgraduate, we need to look to developing more hospital specialists doing outreach but
significantly a cadre of GP Dermatology specialists. ! therefore write to ask that when we
do eventually achieve an extra year of training for GPs, that you add Dermatology
alongside Psychiatry and Paediatrics as an area that that year should cover for a
significant number of doctors.

Seminar participants were very eloquent about the patient need and the way that their
profession is not able to respond effectively. We owe it to the patients to take this
forward.

With best wishes



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PS !t made me realise that ! should invite you to send a senior member of your team to
future science and policy workshops, so ! will be in touch once we've set the next
couple up.

cc Professor Chris Bunker