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Rapid response to:


Transfer of services from NHS to private provider was “unmitigated disaster,” report says

BMJ 2015; 350 doi: (Published 09 June 2015) Cite this as: BMJ 2015;350:h3161

Rapid Response:

Re: Transfer of services from NHS to private provider was “unmitigated disaster,” report says

Dear Madam,

We were glad your article (“Transfer of services from NHS…”, 9 June 2015) noted Circle has provided a good dermatology service in Nottingham, where we treat over 90% of all patients in the pathway.

However, it missed three crucial facts.

First, dermatologists employed by Nottingham University Hospitals (NUH) have been working for Circle, in our Treatment Centre, since we started providing services in 2008. They were only required to fully transfer their employment to us in 2013, as a result of changed employment law at a national level.

Second, the independent review noted that dermatology staff who did transfer thought Circle is a good employer, felt empowered by Circle's model of clinical leadership, and would encourage their colleagues to think again about Circle.

Finally, to place the issue in context, 4 dermatologists chose not to transfer to us. One subsequently came to work for us anyway. Across the entire hospital, 119 NUH staff did chose to transfer.

These facts all point to the same conclusion: this is not simply about working for private partnership like Circle.

The independent review makes it clear that the solution is for all the main parties to work closely together, and Circle fully commits to collaboration with NUH and commissioners on securing services. We have already started, for example, supporting the acute service with our team.

The issue at stake, though, is one being faced across the NHS and across different specialties. Demand is going up, the workforce is not always expanding at the same pace, and funding is tight. In dermatology, this combination of long-term trends has led many, such as the Kings' Fund (commissioned by the British Association of Dermatologists) to argue that alongside increasing training places, part of the answer has to be service transformation, involving better use of technology, self-care, using trained nurse and GP specialists, and better diagnosis.

Circle's approach has been to try and lead that transformation. In dermatology that has included a teledermatology service that we launched last week – which comes on top of other changes like nurse specialists and investing in mohs surgery. But the attitude of seeking to innovate applies across all specialties, and our firm belief is that only strong clinical input can create sufficiently imaginative and forward-looking solutions. The example of Nottingham shows that leadership is required for the NHS to navigate a challenging time - and that will be most powerful when it is driven by clinicians.

Yours sincerely,

Paul Manning DM FRCS

Consultant Orthopaedic Surgeon

Clinical Chairman, CircleNottingham

Competing interests: PM is clinical chairman, Circle Nottingham

23 June 2015
Paul Manning
Consultant orthopaedic surgeon and clinical chairman
Circle Nottingham