Dermatology Services (Kent & Medway) - Market Engagement

The West and North Kent HSCPs are seeking to commission a lead provider model whereby the provider will deliver a consultant led (but not exclusively consultant delivered) Level 1-4 service supported by a multi-disciplinary team which will manage a range of Dermatological conditions.

The description for Levels 1 - 4 are as follows:

Level 1 Self-Care - People with skin conditions who manage their conditions themselves should be supported with high-quality patient information and input from suitably trained nurses, patient support groups and community pharmacists. Ideally patients presenting with conditions that could be managed with self-care should be referred to their local community pharmacy and be supported to self-manage their condition. Community pharmacists are able to advise on a range of common skin conditions, included but not limited to allergic rashes, dry skin conditions such as eczema, minor skin infections, warts and verrucae.

The new service will be expected to work with Primary Care and patients to develop a programme of education around low level management of skin conditions which would not be routinely referred to the new service. To further support patients however the provider will be required to identify a range of voluntary sector organisations who specialise in supporting patients with skin conditions and who offer group support for patients. This educational programme will need to be inclusive of all patient groups and therefore accessibility and representation (of those groups) should be considered throughout the programme.

Level 2 Generalist Care - People with skin conditions needing generalist care are managed initially through self-referral to their GP. Ideally these patients should be managed within the GP practice. As noted above, the provider will be required to develop training and management of Level 2 conditions within the practice.

Level 3 Intermediate and Specialist Care - Any patient whose skin condition cannot be managed by a generalist will need to be referred for specialist care and will need to be managed by a specialist in the community setting; which includes the 2 ww pathway.

Level 4 Supra-Specialist Care - The Management for complex and/or rare skin disorders including 2 ww pathways. These services were historically delivered from a secondary care setting by a consultant dermatologist.

This service will include referrals for 2 ww pathways. Where a treatment that is not within the remit of the service is required the provider would be expected to have a partnership working arrangement with a specialist (acute) provider for the provision and management of this cohort of patients, including the referral pathway and process.

The provider will be expected to deliver a 'one stop' service model which offers timely access to diagnostics and treatment; discharging patients back to their own GP for ongoing management or onward referring where necessary, in line with local pathways and guidance. Referrals will be directly bookable on e-RS with the option to refer to a 2ww or routine teledermatology clinic; unless the patient meets the exclusion criteria where an outpatient appointment can be directly booked. The provider will be expected to review all outpatient referrals to ensure they meet the exclusion criteria prior to appointment.

The commissioner is seeking to procure a lead provider model which also includes a single point of access (SPA). The EKCDS will be expected to manage the SPA.

The service will provide and deliver a consultant led (but not exclusively consultant delivered) Level 1-3 service supported by a multi-disciplinary team which will manage a range of dermatological conditions.

Level 4 services will remain with East Kent Hospitals University Foundation Trust (EKHUFT), however, the community services will be expected to fully integrate with the Level 4 service and ensure referrals seen in the acute setting are those that only really need to be there.

The descriptions for Levels 1 - 4 are as follows:

Level 1 Self-Care - People with skin conditions who manage their conditions themselves should be supported with high-quality patient information and input from suitably trained nurses, patient support groups and community pharmacists. Ideally patients presenting with conditions that could be managed with self-care should be referred to their local community pharmacy and be supported to self-manage their condition. Community pharmacists are able to advise on a range of common skin conditions including, but not limited to, allergic rashes, dry skin conditions, such as eczema, minor skin infections, warts and verrucae.

The new service will be expected to work with Primary Care and patients to develop a programme of education around low level management of skin conditions which would not be routinely referred to the new service. To further support patients, however, the provider will be required to identify a range of voluntary sector organisations who specialise in supporting patients with skin conditions and who offer group support for patients. This educational programme will need to be inclusive of all patient groups and therefore accessibility and representation (of those groups) should be considered throughout the programme.

Level 2 Generalist Care - People with skin conditions needing generalist care are managed initially through self-referral to their GP. Ideally, these patients should be managed within the GP practice. As noted above, the provider will be required to develop training and management of Level 2 conditions within the practice.

Level 3 Intermediate and Specialist Care - Any patient whose skin condition cannot be managed by a generalist will need to be referred for specialist care and will need to be managed by a specialist in the community setting.

Level 4 Supra-Specialist Care - To be provided by EKHUFT - the management for complex and/or rare skin disorders including 2 weeks wait (2ww) pathways and the use of biologic therapies, which is Level 4 only. These services were historically delivered from a secondary care setting by a consultant dermatologist. This will include paediatric services.

The provider will be expected to deliver a 'one stop' service model which offers timely access to diagnostics and treatment, discharging patients back to their own GP for ongoing management or onward referring, where necessary, in line with local pathways and guidance. Referrals will be sent via a single point of access (PAS) on eRS or equivalent.