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BAD Commissioning Report

Summary of the British Association of Dermatologists’ (BAD) report Lessons for the NHS (July 2013)

The BAD report concerns issues and problems involved in the commissioning of NHS dermatology services.  It is based on the Association’s experience of tackling a number of commissioning decisions that affect access to care for Dermatology patients. A particular concern is the frequent lack of understanding amongst commissioners of the multidisciplinary nature of the care pathways, staffing and facilities required to treat acutely unwell patients with inflammatory skin conditions and skin cancer.  However, the report also recognises that non-life threatening conditions can have a substantial psychological impact on everyday life, work, social interaction and healthy living.  It does not specifically mention vitiligo (there are well over 1000 dermatological conditions) but it is relevant to those involved in the care of patients with vitiligo.

Lessons for the NHS is written for clinicians, service managers and Commissioners, highlighting areas where common mistakes have been made with commissioning in the past.  At the beginning (pages 4-6) there is a short guide of ‘top tips’, a list of practical measures which can be taken to deliver ‘high value, effective and timely services which will support  all Dermatology services and clinical pathways’.  This is followed by general recommendations about such issues as the need for developing clear standards, effectively communicating the concept of local care and developing a long-term, joined up approach to data recording.

The main body of the report goes into detail about aspects of commissioning dermatology services, arguing that the new NHS commissioning model provides the opportunity to address previous mistakes.  Each section has a clear list of points which should be considered in the commissioning process.  They deal with:

  • Involving the public and patients in the development and delivery of services;
  • Carrying out a needs assessment exercise;
  • Reviewing current service provision;
  • Deciding and agreeing on priorities;
  • Designing services to improve systems and pathways of care;
  • Identifying suitable and responsive providers, using contracts which clearly set out service expectations;
  • Monitoring the use and effectiveness of services;
  • Dealing with the unintended consequences of system change.

The guidance on the above topics is backed up by summaries of 22 cases where the BAD has been involved in giving advice on (and usually also challenging) commissioning decisions (pages 34-49).