Introduction of intermediate care dermatology services in Norfolk, England was followed by a 67% increase in referrals to the local secondary care dermatology department

Abstract

Funding sources: none. Conflicts of interest: N.J.L. is Honorary Secretary of the British Association of Dermatologists which owns the BJD. Madam, In the U.K., 54% of people have skin disorders each year, for which 24% of the population visit their primary care doctors (general practitioners, GPs), producing 20–25% of their total workload.1, 2 In 2009–2010, 880 000 people were referred in England to secondary care dermatology3 (approximately 16 per 1000 population4) and were seen by teams led by the 423 (whole‐time equivalent) consultant dermatologists working in England (British Association of Dermatologists Workforce data 2010, personal communication). Although this dermatology system is remarkably efficient compared with European and U.S. systems, there has been pressure for change and services for dermatology in the community have been set up since 2005. The Norfolk and Norwich University Hospital (NNUH) provides dermatology secondary care services to approximately 600 000 people in Norfolk, England. This is a predominantly ethnically white, rural area with limited population growth (approximately 9% over 1999–2010) and limited migration in or out of the region. There are no other dermatology secondary care providers, with the nearest hospitals being over 40 min travelling time by road.