Conflict of interest: none declared.
Viewpoints in dermatology ● Correspondence
2011–2012 survey and audit of phototherapy services in the West Midlands, UK
Article first published online: 15 JUL 2013
© 2013 British Association of Dermatologists
Clinical and Experimental Dermatology
Volume 39, Issue 1, pages 65–66, January 2014
How to Cite
Powell, J. B. and Kaur, M. R. (2014), 2011–2012 survey and audit of phototherapy services in the West Midlands, UK. Clinical and Experimental Dermatology, 39: 65–66. doi: 10.1111/ced.12199
- Issue published online: 17 DEC 2013
- Article first published online: 15 JUL 2013
- Manuscript Accepted: 7 APR 2013
Phototherapy is widely used by dermatology departments to treat a wide range of both common and rare skin diseases. Recently the British Association of Dermatologists (BAD) published minimum standards for phototherapy services in the UK. In September 2011, we set out to identify all centres delivering phototherapy within the National Health Service (NHS) in the West Midlands (WM), an area covering 13 000 km2, with a population of around 5.5 million as of 2010. Our aims were to assess the range of phototherapy services being delivered in the WM, and to audit against some of the key standards set out in the BAD document.
In total, 18 phototherapy centres were identified, and all had replied to our questionnaire by December 2012. The results showed a wide range of phototherapy services currently being delivered in the WM by a total of 65 phototherapists using 30 phototherapy booths. All 18 centres provide whole-body narrowband ultraviolet B (NB-UVB), and just over half of these (10 centres) offer hand and foot NB-UVB. Systemic psoralen ultraviolet A (PUVA) is offered by 16 centres and bath PUVA by 12. Of the 18 centres, only 6 (33%) are part of a phototherapy network.
Focusing on the key BAD minimum standards, we found that a named lead phototherapist is present in 17 centres, and a named lead phototherapy consultant in 7 (39%) centres. All 18 centres use phototherapy guidelines, but only 4 centres (22%) conduct a yearly audit of their department, and 3 (17%) conduct a yearly audit that includes adverse incident data. Of the 18 centres, 5 (28%) used minimal erythema dose (MED) testing to determine starting dose.
Thus, the WM offers a broad range of phototherapy services, delivered by large numbers of phototherapists using a wide variety of phototherapy equipment at multiple sites. However, not all phototherapy centres within the WM have a named lead phototherapy consultant, a finding that has been highlighted in previous UK phototherapy surveys. Having a named lead phototherapy consultant is important for leadership service development, clinical governance, teaching and training, and is made all the more important because phototherapy is known to be a relatively high-risk area of litigation within dermatology in the NHS.[3, 4] MED testing is not widespread within the WM or the UK as a whole, even though it is described as ‘desirable’ in the BAD minimum standards.[1, 5]
Currently, only two phototherapy networks exist in the UK: the National Managed Clinical Network (MCN) for Phototherapy in Scotland (www.photonet.scot.nhs.uk) and The South-east of England Phototherapy Network (www.phototherapysupport.net). Not all phototherapy centres in the WM are part of a phototherapy network. Being part of an MCN can assist with keeping guidelines up to date; help with training, auditing and access to expert advice; and be an important link to the wider phototherapy community. The establishment of further regional and national phototherapy MCNs could greatly benefit phototherapy services in the UK.
Only a minority of phototherapy departments in the WM conduct yearly audits of their services with the inclusion of adverse incident data. It is known that around 0.8% of all treatments result in an acute adverse event, but only 0.05% and 0.3% are considered to be severe for NB-UVB and systemic PUVA, respectively. A yearly audit can assess adverse incident rates as a marker for safety and numbers of treatments needed to achieve a ‘successful’ treatment response as a marker of efficacy and efficiency. Data for comparison of safety, efficacy and waiting times have already been published, and may also be available through MCNs.[1, 4, 5] Together, this simple and easily obtainable information can help to identify underperforming photodermatology services.
This study is the first to compare phototherapy services with the BAD minimum standards, and is likely to reflect phototherapy services currently being delivered in other regions of the UK. The BAD minimum standards provide a framework for standardizing and improving phototherapy services across the UK.
- 1British Association of dermatologists Working Party Report on Minimum Standards for Phototherapy Service. Available at: http://www.bad.org.uk/Portals/_Bad/Clinical%20Services/BAD%20Working%20Party%20Report%20on%20Phototherapy%20Services%202011v8%20final%20draft%20Logo.pdf.
- 2An audit of the provision of dermatology services in secondary care in the United Kingdom with a focus on the care of people with psoriasis. Available at: http://www.bad.org.uk/Portals/_Bad/Audits/BAD%20Psoriasis%20Audit%2018.02.08.pdf (accessed 13 April 2013)., , et al.