SURVEY OF QUALITY ISSUES IN DERMATOLOGY SERVICE CONTRACTS

Most hospitals now have acquired trust status and managers have started the process of setting contracts with purchasers. In order to assess quality content of contracts for dermatology services, performed on behalf of the British Dermatologists' (BAD) Audit Subcommittee. A letter was sent to 278 consultant members of the BAD, requesting a copy of their contract: 171 (62%) replies were received. Seventy-four consultants had formal contracts with purchasers, but only 25 (34%) of these had been involved in contract preparation. Several consultants were unsure whether formal contracts existed and many had difficulty in obtaining the documents. The 20 contracts received were highly variable, with a median of 13 (range 0-89) quality clauses per contract. These mostly related to the process of care, particularly waiting times and communication with general practitioners (GPs). Sometimes the structure for delivering care was specified, but only occasionally were outcome measures mentioned. The specified maximum waiting time for a new patient appointment ranged between 4 and 30 weeks (median 13). GPs were to be sent out-patient letters within 3-10 days (median 10) of patient attendance. Following in-patient care a notification was to be sent within 1-3 days (median 2) of discharge and a full summary within 7-21 days (median 12). A requirement for patient satisfaction surveys was included in only six contracts. Greater involvement of consultant dermatologists in setting contracts with purchasers should lead to the inclusion of more consistent and appropriate quality clauses. The ease of collection of certain process data should not distract from the need to examine the outcomes of clinical care.