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Paediatric Dermatology Statement

Paediatric Dermatology Statement

Approved by the BAD, British Society for Paediatric and Adolescent Dermatology (BSPAD) & British College of Dermatology (BCD)

December 2021

 

Paediatric Dermatology services at both secondary and tertiary level are struggling due to workforce shortages, as identified in the GIRFT report. This has negative training implications for our specialist registrars, further compounded by the covid pandemic. This statement aims to clarify the distinction between secondary and tertiary care paediatric dermatology skills, in order to support both NHS services and training.

 

Secondary care paediatric dermatology skills are a core part of the work of a general dermatologist. Its significance is reflected in the 2021 dermatology curriculum, which identifies paediatric dermatology as one of only seven core dermatology Capabilities in Practice (see Table 1). This emphasises the importance of paediatric dermatology, which is fundamental to the role of dermatologists.  It is therefore essential that all specialist trainees achieve the required paediatric dermatology competences to successfully reach CCT.

 

However, there is a recent trend for some consultant dermatologist job plans to no longer include paediatric dermatology (both out-patient and acute), and as a consequence the term "adult dermatologist" has developed.   As a result, already over-stretched tertiary paediatric dermatology services are becoming overwhelmed with paediatric skin disease which could be managed appropriately by secondary care colleagues. Treatment for many children with dermatology problems is delayed, and patients who do need tertiary level support are unable to access care in a timely manner. Therefore, it is important to cease the segregation of general dermatology from secondary care paediatric dermatology, and continue to view triage and management of skin conditions in children and young people as core work of general dermatology practice.

 

The BSPAD, BAD and BCD acknowledge the challenges involved with seeing paediatric dermatology patients, including the need for separate clinics, waiting areas and specialist paediatric nursing staff. However, in order to adequately serve the entire population of those with skin disease, it is necessary that triage and management of many paediatric dermatological conditions should be a core requirement in the job plans of most secondary care dermatologists, and that this is not considered to be a specialist area only for dermatologists with advanced paediatric dermatology training. Local teams are encouraged to work with their NHS Trusts to overcome barriers to enable this.

 

Furthermore, access to tertiary  paediatric dermatology expertise where appropriate is also required. Going forward, we particularly encourage trainees with an interest in tertiary-level care to pursue the Paediatric post-CCT fellowship, whose curriculum was designed by the BSPAD and approved by the Dermatology Specialist Advisory Committee, as there is a strong need for uplift in this specialised skill set. The BSPAD, BAD and BCD are also aware of the additional responsibility and workload required by tertiary programmes to act as training centres, and we aim to work together to encourage the development and sustainability of such posts.

 

Over the coming months, the BSPAD, BAD and BCD will provide guidance to support the issues described above.

 

Table 1:

Learning outcomes – Capabilities in Practice (CiPs)

Generic CiPs

  1. Able to successfully function within NHS organisational and management systems
  1. Able to deal with ethical and legal issues related to clinical practice
  1. Communicates effectively and is able to share decision making, while maintaining appropriate situational awareness, professional behaviour and professional judgement
  1. Is focussed on patient safety and delivers effective quality improvement in patient care
  1. Carrying out research and managing data appropriately
  1. Acting as a clinical teacher and clinical supervisor
  2. o be assessed by DOPSitionscurriculum

 

Specialty Dermatology CiPs

  1. Outpatient dermatology: managing dermatology patients in the outpatient setting

 

  1. Acute and emergency dermatology: managing dermatological emergencies in all environments and managing an acute dermatology service including on-call

 

  1. Liaison and community dermatology: working in partnership with primary care and promoting skin health

 

  1. Skin tumours and skin cancer: managing a comprehensive skin cancer and benign skin lesion service

 

  1. Procedural dermatology: performing skin surgery and other dermatological procedures

 

  1. Paediatric dermatology: managing paediatric dermatology patients in all settings

 

  1. Other specialist aspects of a comprehensive dermatological serviceincluding:

7A) cutaneous allergy

7B) photobiology and phototherapy

7C) genital and mucosal disease

7D) hair and nail disease

 

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