Welcome to the first in our new blog series, Conversations With Clinicians, a collection of informal interviews with NHS stalwarts, influencers and trailblazers.
To mark the publication of his new book Under the Skin: A Dermatologist’s Fight to Save the NHS, we spoke to Professor Alex Anstey about the biggest challenges currently facing our healthcare service.
With almost 40 years’ experience working in the NHS, Alex holds an invaluable perspective on the impact of change within the health service. He has worked as a consultant dermatologist for the past 28 years, served as editor of the British Journal of Dermatology between 2013-2019, and is now an honorary professor at both Cardiff and Bangor universities.
Sitting down to talk to Cinapsis, he discusses his extensive experience of working within the British healthcare system, why advice and guidance is such a powerful tool for clinicians, and his hopes for the future of the NHS.
In your book you weave social history with your own personal history and the evolution of dermatology care in the NHS. Do you believe that social and political events have, and always will, influence the way that healthcare is delivered in the UK?
In short: yes, I do. The pandemic was particularly brutal at highlighting how social inequality made the poorest in UK society especially vulnerable to a bad outcome from Covid-19. The UK ranks 17th out of 18 developed countries for income inequality, and we saw this play out during the pandemic when the most socially disadvantaged faced the worst outcomes. Addressing this is a matter of urgency if we are to create a more just society.
Within health and healthcare, this issue presents itself in the so-called inverse-care law, in which the best care is given to the most affluent communities, while the most disadvantaged communities receive much lower standards of healthcare. I have experienced this first-hand during my time working in the NHS, and it’s something that I explore throughout my book.
Your work has demonstrated beyond doubt the value and impact of the advice and guidance model. What do you see as the biggest barriers to more widespread adoption of this style of clinical practice?
Change happens at different speeds in different places. So while we’re seeing advice and guidance being fairly widely adopted across dermatology, implementation will look wholly different for many other specialisms. However, the case for introducing faster interaction between GPs and specialist clinicians through advice and guidance is very strong. It is hard to argue against it; to me, the case for using it is a no-brainer.
There are always early adopters, closely followed by a first wave of wider users. Gradually, more sceptical adopters begin to come onboard. A minority unfortunately remains resistant to change; but the more we are able to demonstrate the benefits, the greater confidence we can build to drive wider adoption.
What needs to be done, or to change, to overcome these barriers?
This is a great question! At the end of the day, no one wants to be left behind. When teams begin to realise that the advice and guidance model is being adopted and implemented successfully elsewhere, and they see the positive impact this different mode of working can have on waiting lists, they are likely to follow suit.
How much of an impact can advice and guidance have on waiting times and/or reducing pressure on NHS services?
The impact is huge. In Bangor, for example, we’ve successfully changed the profile of waiting lists from mountains of work to gently rolling foothills. In Bath, our waiting lists are also consistently short. At both hospitals, the advice and guidance model that we’ve introduced provides the core of a highly efficient and productive service.
How has using Cinapsis impacted on your practice as a dermatologist and why are you advocating for your colleagues to adopt it too?
It has, quite simply, changed my practice beyond recognition. I am currently looking forward to formalising teledermatology training for dermatology trainees. We have identified six key levels of learning, which we hope will be a helpful concept as we move towards more standardised and rigorous teledermatology training across the UK.
Having used Cinapsis myself for over six months now, I’ve been impressed by its functionality and the fact it can be customised and tweaked to suit each individual unit. By far, one of the best features is that it is integrated with GP and hospital patient records - this is just invaluable.
How can patients and clinicians be supported and encouraged to become more involved in service design?
This is something I’ve endeavoured to provide answers to throughout my book. In my experience, very few dermatology units are using patients to help design their services. As such, they are really missing a trick!
In Newport, my team benefited from instituting a successful patient panel, for example - but initiatives like these do take time and effort to create and then sustain. I think the most important thing for organisations to remember is to avoid falling into the danger of patient engagement becoming purely tokenistic.
What one thing would you change about the way the NHS currently operates, if you had the chance?
This is a theme that really forms the backbone of my book: integration between primary and secondary care. I strongly believe in this, and I don’t think that this concept is by any means limited to dermatology. Generalists and specialists must make greater efforts to work together and collaborate, in the interests of better patient care.
I really hope that we will see the NHS gain a new lease of life by growing more independent from political governance. In my opinion, the past 12 years have been a masterclass in how not to run the NHS.
Moving forward, I believe the following three issues need to be addressed. Firstly, there needs to be a long-term strategy which clearly supports the ambition to reinstate the NHS as a best-in-class healthcare provider. Secondly, we need to see funding increasing by around 4% annually, for at least the next 10 years, in order to make up lost ground. And finally, we need a clear workforce strategy. Without sufficient staff numbers, and the right mix of skills and experience, the NHS as we know it will simply become impossible to run.