Agenda item

In September 2018, Medway NHS Foundation Trust (MFT) served notice on their Dermatology service (including the cancer pathways), following which the North Kent CCGs jointly commenced procurement to identify a new provider to deliver Dermatology services. Following a successful procurement process the contract for the North Kent Dermatology Service was awarded to DMC Healthcare. The new service commenced on 1 April 2019.

In view of concerns raised, it was agreed at the agenda planning meeting held on 29 May that a report should be included on the agenda for the June 2019 meeting.

Discussion

Medway NHS Foundation Trust (MFT), the previous provider of Dermatology Services, had served notice on the contract in September 2018. This followed challenges relating to the service, including increasing waiting lists and it not meeting national targets. Following a procurement process, DMC Healthccare had won the contract to provide Dermatology services, with the new service having commenced in April 2019. At commencement of the new contract there had been a significant number of patients on waiting lists and NHS Medway Clinical Commissioning Group (CCG) had not been aware of the extent of the waiting list. The MFT provided service had been breaching 52 hour wait targets and in March, it was reported that only 4% of cancer patients were seen within the two week target.

The task of moving the Dermatology Service from a hospital to community based service had been challenging, particularly in view of the unexpectedly high number of patients. Nurses responsible for delivering the service had successfully transferred from MFT to DMC Healthcare. However, none of the consultant dermatologists had transferred. This had been particularly challenging as DMC had understood that these consultants would transfer. DMC had established a system of electronic notes with notes from the previous MFT provided service having been uploaded to the system. In April 2019, DMC had received 46,000 phone calls as MFT had advised patients to contact DMC Healthcare. This high call volume had presented a significant challenge. DMC had run additional clinics in order to reduce the backlog of patients waiting to be seen. An advantage of the new service was that, for many patients, services were now being provided closer to their home. DMC Healthcare was in the process of acquiring a phototherapy machine. This was due to be installed at Rainham Healthy Living Centre the week after the Committee meeting and patch testing was due to commence within the next four weeks. Staff were positive about how the new service was running. The aim was to build on this, to provide further training and to recruit a full time dermatologist. It was acknowledged that establishing the new service had been difficult.

In response to Member questions about the size of the waiting list and when it would be cleared, recruitment plans and the difficulty patients faced in getting GP appointments, it was confirmed that the waiting list inherited from MFT had been 8,800. This had been reduced to the current figure of around 8,000. Engagement had taken place via practice learning events at each of the Kent and Medway CCGs to tell clinicians about the new service and to promote the adoption of a dermatology app. There was a national shortage of dermatologists with it being considered that word of mouth was more likely to be successful for recruiting dermatologists than the formal advertising of vacancies. Patient feedback was important, this would be shared at monthly commissioning meetings. 

A clinical triage process had been undertaken to review patients who had been on the waiting list for an extended period. The number of patients inherited from the MFT provided service had been significantly higher than anticipated and this had not been known during the tender process. The number of clinics provided by MFT in the period immediately prior to DMC taking over as provider had also reduced resulting in the waiting list having increased. The aim was for the waiting list to be cleared in the next three to six months. The number of serious cases waiting more than two weeks had been significantly reduced as had the number of patients waiting more than 52 weeks. At commencement of the DMC contract on 1 April there had been 120 patients waiting more than 52 weeks. It was anticipated that this would be reduced to zero by the end of June 2019.

Work to implement a single point of access at GP practices had been hampered by IT problems that were not within the control of DMC Healthcare and it had therefore not been possible to provide the level of service anticipated. Implementation meetings had taken place during January, February, March and April 2019. Nationally, the NHS was promoting other skilled professions that related to general practice, with a view to this supporting the provision of GP services. This included roles such as clinical pharmacists and clinical physiotherapists.

A Committee Member said that the issues associated with the procurement process, particularly a lack of awareness of patient and waiting list numbers were reminiscent of a previous procurement undertaken for patient transport services. The Member asked why commissioners had not known about the scale of the waiting list and why it had been anticipated that consultants would transfer from MFT to DMC Healthcare, when in the event, none had done so.

The CCG representative said that the CCG had been required to undertake a procurement exercise at short notice due to MFT having relinquished its provider contract. The procurement had been reliant on data provided by MFT. This had not indicated the size of the waiting list or other challenges that the service was facing. In relation to the list of staff that had been expected to transfer from MFT to DMC Healthcare, this had been provided in writing but such lists were not final until the point of transfer. It was also possible for staff to change their mind at short notice. MFT no longer had the clinical resources to support the delivery of the service and so could not be asked to help support DMC Healthcare going forward. DMC Healthcare representatives advised that staff who had decided not to transfer had not had to work out their notice periods. Other changes made to improve the dermatology service had included adjusting the referral form to provide more detail, thereby helping to avoid some unnecessary referrals. GPs also had emergency phone access to DMC Healthcare for the purpose of discussing urgent referrals.

A number of Members said that there was an urgent need for the Committee to seek answers from MFT and that MFT representatives should be asked to attend Committee.

Decision

The Committee noted and commented on the report, agreed that a further update be brought to the next meeting of the Committee and agreed that representatives of Medway Foundation Trust be asked to attend.