GPS IN DONEGAL are concerned that patients in the region with melanoma, a highly time sensitive skin cancer, will “suffer poorer outcomes” as a result of Letterkenny University Hospital (LUH) losing its dermatology service.

The service has collapsed following the retirement of a senior dermatologist at the Co Donegal hospital.

A few weeks ago, the consultant dermatologist at Sligo University Hospital (SUH) wrote to GPs in the region to inform them that all referrals were now being directed to him. 

SUH is a 1 hour 40 minute drive from LUH at a minimum, and nearly three hours away via public transport. 

Dr Dermot McKenna claimed that management within the Saolta University Health Care Group were aware that the post within LUH would be vacant well in advance, and questioned what “if any” planning had been done in preparation for the scenario. 

McKenna wrote that the lack of a dermatology service in LUH will result in “delayed diagnosis” for patients, impacting “melanoma survival”, patients with eczema and psoriasis, and teenagers with acne who are at risk of scarring. 

He said that patients’ lives will be “destroyed” because of an inability to gain access to care. 

McKenna added: “Donegal patients already make treatment decisions based on distance to travel.”

Though the SAOLTA hospital group has secured funding to appoint two new consultant dermatologists in the northwest region, but The Journal understands that despite funding for new posts having been available for some time, it has been extremely difficult to attract appropriate candidates, specifically in Donegal. 

In the area of dermatology, there are many highly paid vacancies in the private sector, in more built up areas. 

SAOLTA has also stated that the LUH dermatologist who ran the weekly clinic in the hospital has now agreed to come in once a month to see existing patients on treatment programmes, and those who require ongoing monitoring. They will not, however, being taking on new referrals. 

Grave concerns 

Dr Padraig McGuinness from the Donegal General Practitioners group said that GPs in the region have “grave concerns” about the loss of the service. 

“Our patients will continue to have to travel long distances to already-stretched services in Sligo, Galway and Roscommon,” McGuinness said. 

He explained that melanoma in particular is a “highly time sensitive cancer”, and that he and other doctors are concerned that patients will suffer poorer outcomes because of a delay in access to local services. 

“Despite a lead in time to this well-anticipated and expected retirement, it is regrettable that Saolta did not act to fill the post which now lies vacant at the hospital,” McGuinness told The Journal. 

The Donegal General Practitioners group is calling on Saolta  management to “urgently” put a dermatology service in place in the North West that will see patients with suspected skin cancers and other conditions treated swiftly. 

In his letter to GPs, McKenna said that dermatology services in the entire region have been “quite frankly dismantled”. 

The dermatologist said that he is dealing with “thousands” of patients awaiting their first appointment, with a wait time of four years. 

He explains that as he can only see patients with urgent referrals from his waiting list at the moment, it is very hard to recruit another dermatologist into the northwest area, as the service is highly backlogged. 

McKenna wrote, in the letter dated 20 October, “today I have triaged over a hundred new GP dermatology referrals onto the Letterkenny waiting list alone.”

He added that he has not had advice from management on what to do with LUH patients that require “skin cancer follow up”, or how to deal with the monitoring of drug treatments and repeat prescriptions that can only be written by a consultant.  

No examination lighting

McKenna said it is “simply not possible” for him to absorb all of the LUH patients. 

He wrote that his service now has “less nursing hours” than 20 years ago, and that he can’t get an examination light installed to “properly examine patients after two years of trying”. 

It is understood that the SUH dermatology service does not have lighting for examination purposes beyond a normal ceiling light. 

McKenna also claimed that his service’s secretarial office space has been halved, and that he can’t get “adequate” secretarial support. 

Outlining how services have, in his view, been reduced in the region, he said: 

“From the non-appointment by management of an excellent dermatologist in 2014, despite funding being in place, to GUH being allowed to withdraw [the] dermatology service from Roscommon and Ballina with no consideration of the adverse impact on my service in the northwest.” 

The consultant noted that Galway University Hospital has had some expansion of its dermatology service, but that there is no “assistance” in dealing with the LUH patients forthcoming from the hospital. 

McKenna also voiced his fears for the future of his own service, and his concern that eventually, Galway University Hospital will have to care for “all dermatology” in the region.

The Saolta hospital group issued the following statement to The Journal: 

“The model for Dermatology care in the Northwest has always been a service based from Sligo University Hospital and this remains the case.

“Historically this service was supplemented by a consultant from Northern Ireland who ran a weekly clinic in Letterkenny, funded by LUH. Regrettably this consultant is no longer in a position to continue running this weekly clinic. However, the consultant has agreed to continue a monthly clinic to provide clinical care for existing patients who are currently on treatment regimes or in surveillance programmes that require on-going monitoring.

“Saolta has secured funding for two new consultant dermatology posts for the Northwest and LUH management have identified a requirement that the appointment of these posts would deliver two clinics per week in Letterkenny.

“Recruitment for these posts is currently underway.”