Views on Nottingham dermatology and why I had to leave
As one of the consultants involved, I read with great interest Gareth Iacobucci’s article regarding dermatology services in Nottingham (BMJ 2015;350:h3161). Looking back, it was no surprise that Circle won the tender to continue running Nottingham NHS Treatment Centre. Such private companies remain in existence through expertise in this process; by contrast, most NHS bodies have had no experience in preparing bids and the playing field is thus not a level one.
It is ironic that Circle was able to demonstrate the delivery of excellent patient care over the previous five years as this was largely down to clinical staff seconded from the NHS. Iacobucci writes that there was an expectation that dermatology staff would be transferred to Circle’s employment after renewal of the contract, in contrast to the previous secondment model. Unfortunately, this was not communicated in advance to the staff involved. Having trained and always worked in the NHS, I did not wish to work for a private company but the choice was to accept or resign. The dogma that private enterprises will improve care whilst turning a profit is in my view fallacious – my observation is that the two goals directly conflict. Furthermore, I had concerns about the long-term viability of Circle in Nottingham: their demise would result in further uncertainty for me and my family.
When the Transfer of Undertakings (Protection of Employment) (TUPE) plan became apparent, the dermatology consultants wrote to Rushcliffe Clinical Commissioning Group (copying the letter to many other interested parties), informing it that some consultants would leave rather than work for Circle, and that recruitment to replace them would be difficult given numerous vacancies across the UK. We highlighted the enormous potential consequences of this to patient care, training future dermatologists, teaching medical students and research. As the recent independent review mentions, the commissioners patronisingly interpreted this as some sort of bereavement response and did not seem to take our views seriously. Given my family circumstances, I chose not to resign but moved back to the NHS as quickly as practical, to a fixed-term position in the new dermatology service set up by Nottingham University Hospitals NHS Trust (NUH) at City Hospital.
As this was in line with the patient choice and “any qualified provider” agendas, and given the benefits to patients living in north Nottingham, it seemed logical that this post would become permanent once the service was more established. We received plenty of referrals and excellent feedback from patients. This service had the potential to safeguard acute and paediatric dermatology services, whilst allowing Circle to continue to cherry pick the simpler, more profitable adult elective work.
I believe that further consultant recruitment at NUH would have followed, allowing for a viable two-service model across the city and maintaining the provision of training, teaching and research. The new NUH service began at a time when Circle was depending on increasing numbers of locums, some not even on the specialist register. In actively blocking the City Hospital service, the CCG did not so much look this gift horse in the mouth, but shot a bolt through its head. From my standpoint, it was this lamentable decision that sealed the demise of dermatology for the people of Nottingham and I find it surprising that the key decision-makers in the CCG continue in their posts. It was at this point that an excellent opportunity arose for me elsewhere. Despite the upheaval for my family and regret at leaving my Nottingham patients, I could not refuse the promise of a secure position in a stable department.
It is to be hoped that such a debacle is not allowed to happen again.
Competing interests: No competing interests