Dermatology Workforce Service Forecast

Dermatology Workforce Service Forecast

Health Workforce New Zealand

November 2014

Table of Contents

Executive Summary 3

The report notes that support is needed for public Dermatology as a specialty as a matter of urgency. The report proposes that Health Workforce New Zealand, business units of the Ministry of Health and district health boards develop a cohesive plan that provides a sustainable, public sector dermatology service and workforce in New Zealand for 2020. 4

Introduction 4

Methodology 5

Dermatology in New Zealand 6

What is Dermatology? 6

The burden of disease 6

Skin cancer 6

Health Loss 7

Data on Hospital Services 7

Data on GP Services 7

Comparative ratios of Dermatologists: Population 8

Academic Dermatology 8

Current New Zealand Dermatology workforce 8

The vision for Dermatology in 2020 15

Discussion 17

Dermatology service in New Zealand 18

Workforce 19

Specific service issues 23

Recommendations 28

Appendix 1: Dermatology Workforce Service Forecast Group 30

Appendix 2 Examples from literature (New Zealand and overseas) 31

Appendix 3: Vignettes 42

Appendix 4: ACC Claims 47

References 51

Executive Summary

From July to November 2013, the Dermatology Workforce Service Forecast group (the Group) was formed to develop a vision for dermatology services in New Zealand in 2020 and beyond, describing possible model or models of care that are patient-centred, team based and build in primary care where appropriate.

The Group’s vision for dermatology in New Zealand in 2020 is ‘that patients will have equitable access to an integrated, consultant-led service that delivers high quality health care’.
The Forecast was informed by literature reviews, the experience and knowledge of the Group members, the use of scenarios to illustrate current practice and information provided by individual district health boards (DHBs) and Health Workforce New Zealand (HWNZ).
This process highlighted a number of issues, the main ones being highlighted below.

• 
  There is an urgent need to develop a career pathway for public hospital dermatologists and to increase Senior Medical Officer (SMO) dermatology posts. There are very few SMO dermatologists working in public hospital practice, compared to private practice due to a lack of substantive public positions.
  
• 
  Access to publicly funded dermatology services in New Zealand is currently very limited and varies greatly across DHBs and regions.
  
• 
  The range of dermatology treatments offered varies from region to region.
  
• 
  There is an urgent need to ensure the continuity and development of centres of excellence in public hospital dermatology.
  
• 
  Supportive management structures are required to facilitate public dermatology.
  
• 
  Stronger dermatology training and academic capacity is required in New Zealand to enhance the service in New Zealand.
  
• 
  There are very few nurses working specifically in dermatology, with limited or no opportunities for training and further qualifications.
  
• 
  As services are increasingly being delivered outside of the hospital setting, there is a need for more education for General Practitioners (GPs), achieved through better integration with public dermatologists.
  
• 
  A consistent approach to dermatology is required in New Zealand, with agreed pathways, standards and guidelines developed and implemented. This is particularly relevant to the diagnosis and treatment of skin cancer.
  
• 
  Data on dermatology in New Zealand is hard to access and is not routinely recorded or centrally collected
  

In order to address the access issues highlighted, the model proposed by the Group for 2020, identifies the core services that should be delivered safely and efficiently at primary care, DHB, regional and national levels. Delivery of services requires appropriately trained staff, working in collaborative teams to provide accurate diagnosis and treatment plans, which can be delivered in a safe and timely way.

The report notes that support is needed for public Dermatology as a specialty as a matter of urgency. The report proposes that Health Workforce New Zealand, business units of the Ministry of Health and district health boards develop a cohesive plan that provides a sustainable, public sector dermatology service and workforce in New Zealand for 2020.

Introduction

The Workforce Service Forecasts (forecast) are to provide important input into HWNZ planning and decision-making around workforce purchasing intentions and other workforce initiatives.

In July 2013, Dr Darion Rowan was invited to form a Workforce Service Forecast group, to look at the future needs for dermatology in New Zealand. Group members were invited who brought skills, experience and knowledge of dermatology, both in New Zealand and overseas, a dermatology nurse and a local GP. A full list can be found at Appendix 1.
The aim of the forecast was to develop a vision of the relevant health service and workforce for 2020 and beyond, and models of care that are patient-centred, team based and build in primary care where appropriate.
In developing the vision and model the Group needs to take into consideration:

• 
  that the outcomes from this forecast are applicable to the delivery of dermatology services nationally across New Zealand
  
• 
  a likely doubling of health service demand but only a 30-40% increase in funding over the next ten years
  
• 
  that the population is increasing and ageing
  
• 
  maintenance of quality in service provision
  
• 
  a continued need to address inequalities
  
• 
  increased access to quality services
  
• 
  the interface with Plastic Surgery, particularly in relation to skin cancer
  
• 
  a reduction in duplication of services
  
• 
  the ‘triple aim’ of:
  

• 
  an improvement in individuals’ experience of their health care and better individual health outcomes
  
• 
  an improvement in the health and well-being of communities
  
• 
  a reduction in the per-capita costs of health care
  

• 
  that the status quo is only acceptable if there are no superior alternatives, which is not an option for dermatology.
  

The process began in July 2013 and was completed by the end of November 2013.