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					   Action on Meeting, Royal College of Physicians
               London 27 April 2004




The Teaching Hospital Perspective


     Christopher E.M. Griffiths MD FRCP
     The Dermatology Centre, Hope Hospital
     University of Manchester, Manchester, UK.
                   History
   1835   Chorlton-on-Medlock

   1874   Dale Street, Salford
Manchester
Dermatology
Centre 1880
                   History
   1835   Chorlton-on-Medlock

   1874   Dale Street, Salford

   1888   Quay Street, Manchester
                   History
   1835   Chorlton-on-Medlock

   1874   Dale Street, Salford

   1888   Quay Street, Manchester

   1988   Salford Royal Hospital

   1992   Salford Royal Hospital
           Beds at Ladywell Hospital
               Service 1994
   Population 3 million
   12 NHS Trusts
   10 consultant dermatologists
               Some work in 5 Trusts
   Dispersal of “Hub” across Greater
    Manchester
   Few Tertiary services
   No academic lead
   Little or no national profile
Outpatient               Labs
Salford Royal            Medical
                3mi
                         school


         4mi          4mi


                 0.5mi
      Academic              Beds
      Hope                  Ladywell
           Service




Training       Research
            Service : Plan

 Increase number of consultants
 Promote Consultant-led service
 Waiting lists only if recurrent funding
 Consult with GPs and other Trusts
            GP education
            Teledermatology
            Nurse-led clinics etc
                  Service 2004

   25 consultants
   12 Trusts
   Only 1 consultant visits more than 3 Trusts
   Monthly Directorate meeting
   “Hub and Spoke” service
                      Service

                      12 Trusts
Bolton                    -    4 consultants*
Bury                      -    1 consultant
Rochdale                  -    2 consultants
Oldham                    -    2 consultants
Tameside                  -    2 consultants
North Manchester          -    1 consultant
Central Manchester        -    3 consultants
South Manchester          -    3 consultants
Stockport                 -    2 consultants
Mid-Cheshire (Leighton)   -    2 consultants
Trafford                  -    2 consultants
Wigan and Leigh           -    2 consultants

*Some consultants work at more than one spoke Trust
           Dermatology Centre
                    2002 / 2003
   New Patients    11,888
   Return visits   32,527
   Total           44,415

   New patients from Salford PCT 41%
   Tertiary 37%

   Budget £2,573,211
                 Tertiary Services
   Acne
   Contact Dermatitis Investigation Unit
   Laser
   Mohs’ Surgery
   Oral Medicine
   Paediatric Dermatology
   Photobiology
   Photodynamic Therapy
   Phototherapy
   Psoriasis
   Skin Lymphoma
   Vulval Disease
            Tertiary Services

   Mohs’ surgery Dr Telfer to Los Angeles

   Lymphoma Dr Parry to Cleveland, Ohio
    + Christie Hospital

   TEN Dr Craven + nurses to Paris

   Photobiology Dr Rhodes Regional
    service transfer from Liverpool as part of
    academic expansion
      The Manchester Psoriasis Service




Hospital Doctor Dermatology Team of the Year 2002
           Dermatology Centre
                     2002 / 2003

   19 beds; dedicated ward inc. 1 High Dependency Bed

   Inpatient admissions 324

   Average length of stay 20.9 days

   Bed occupancy 99.2%
             Nursing Initiatives

   Nurse-led clinics
     Psoriasis
     Eczema
     Drug-monitoring
   Shared care protocols – community
   Phototherapy service (Quality Award)
   Day treatment centre (Quality Award)
   Teledermatology
             GP Education

   1999 Annual Manchester GP course

   1999 Modular GP course with University
    of Central Lancashire / RCGP
The Dermatology Centre at
     Hope Hospital
   Hub of the “hub and spoke” model of service for Greater
    Manchester

     Spokes provide local services for patients

     Hub provides:
        Specialist services
        Local services for Salford and Trafford
        Academic base (research)
        Undergraduate and postgraduate teaching

   Model for service provision (Managed Clinical Network) for dermatology 25
    Consultants affiliated to the Centre – considerable expansion – doubled in
    past 10 years
   Now being adopted by other centres in the UK
Manchester Dermatology Centre 2004
     Postgraduate Training
   1994 - 4 Registrars/Senior Registrars

   Based at Salford Royal, no part of post at other
    hospitals
     Postgraduate Training


   2004 - Hope is Centre for North West Specialist
    Registrar Training Scheme in Dermatology

   Set up in 1995 with advent of “Calman Training”

   4 year scheme 13 SpRs
     Postgraduate Training


   Year 1 spent in one of the training spokes in North-west England.
    These are not part of the Service spokes
         Macclesfield, Burnley, Blackburn, Lancaster

   Years 2-4 spent at Hope Hospital, one day per week go to a service
    spoke

   Research encouraged, particularly time out of programme for PhD
    / MD
SpR Competency Assessment

   Mini Clinical Evaluation Exercise (Mini CEX)
   Directly Observed Procedural Skills (DOPS)
   360o Assessment
       Medical Student Teaching

   Manchester > 300 students per year
   Problem-based learning course
   Clinical skills
   Special Study Modules
   Research options
   Sign ups
   E-learning
                           Research
   Chair 1994
   Research strengths include psoriasis, ageing, photobiology, clinical
    trials
   Psoriasis
     Immunotherapy
     Outcome measures
     Systematic reviews
     Brain-skin axis
   Ageing
     Molecular biology
     Therapy of aged skin
   Photobiology
     Photodynamic Therapy, Photodermatoses
     Skin cancer
   Immunodermatology
                          Research
   Common diseases
   Psoriasis, ageing/photoageing, PLE, BCC
   Translational – clinically relevant
   Flexibility, opportunism
   Collaborate with the “experts”
   Clinical Trials Unit (Dermatopharmacology)
                Independent of clinical service
                Fully staffed
                Self-financing
                Phase I-IV Trials
                Procurement of clinical samples
    Research Assessment Exercise
   All HEFC funded institutions 2008
   All University Departments
   Assessed on
                Grant money – emphasis on Research Councils
                PhD, MSc, MD students
                Publications and impact factors
                Esteem indicators
   Strive for 5 or 5* status
   2008 Units of Assessment in Hospital Medicine
                Cardiovascular medicine
                Cancer studies
                Infection and Immunity
                Neuroscience
                Other Hospital and Laboratory based clinical subjects
Research




           Knowledge
           Brand name
           Recruit the best
                        Head of Centre



   Clinical Director           STSC Chair       Research
                                                Units


Directors of CDIU,
Photobiology etc        MCN Director        Programme
                                            Director

              Nursing will map on to this MCN
                     Summary
   Main Dermatology Centre in North-West England and
    largest (arguably) in UK – benchmark is Institute of
    Dermatology at St Thomas’ Hospital, London

   National model for “hub and spoke” service provision

   Providing innovation in service delivery

   In top tier of academic centres in UK

   In top tier of training programmes in UK