Views & Reviews Personal View

The UK needs office dermatologists

BMJ 2012; 345 doi: (Published 10 September 2012) Cite this as: BMJ 2012;345:e6006

Re: The UK needs office dermatologists

Professor Rees's conclusions are those that might be expected of a consultant isolated from reality. To be confronted by his Austrian friends questions and not have a cogent answer is, even in a junior doctor, an extraordinary lack of understanding of how the NNHS works and how other health systems work. This lack of insight appears to persist, judged by his conclusion. He should have some insight into the workings of the NHS. We do not have a 'spot doctor' because we have very competent GPs who do the bulk of all dermatology work that the specialists would deem to be beneath their dignity to deal with. GPs do the bulk of consulting, diagnosis, and care at a very low cost and with great efficiency. This contrasts with many specialist departments who complain about trivial referrals mixed with serious problems. They struggle to cope with their workload as it stands. When Professor Rees and his fellow consultants manage to set up their service with no waiting list and one stop consultations then they may be able to compete. The only other conclusion is that he wishes for a ten fold increase in the number of dermatologists to take over the job of the GPs. They would need special training to distinguish all the problems they have little experience of, and be able to manage patients and all their vagaries. This training already exists and produces highly trained doctors with a wealth of experience. They are called GPs.

One of Professor Rees's predecessors in Edinburgh once complained about the quality of GP registrars' abilities in dermatology as judged by the quality and quantity of their referrals. A quick audit by the Post Graduate department responsible for GP education concluded that the quality of referral could be improved but the quantity was very small. The lack of insight demonstrated then seems to continue today.

Competing interests: No competing interests

18 September 2012
Ninian Hewitt
Lothian Health
101 inverleith row