South East England Phototherapy Managed Clinical Network The First Five Years Nichola Mair Project Coordinator

Background For some time it was felt that phototherapists in London and the Southeast England needed support, but exactly what was required was unclear. Inspiration was taken from Photonet Scotland, set up 10 years ago to improve the quality of phototherapy administered in Scotland.

Background It was decided that the best way to find this out, would be to carry out a survey of the services provided, and ask the practitioners themselves what they needed from a network, should one be set up.

Gathering the evidence

What we wanted to know What phototherapy services are available in London and the South East of England? Are these units supported? Are the training needs of staff being met To conduct a “needs assessment” prior to establishing the “phototherapy network”

Gathering the evidence So in 2008 we sent a postal questionnaire to all phototherapy units in the Southeast England area. Summary of information about the audit sent to the Lead Clinician in each unit in August 2008

Results The results of the audit were presented at the BDNG conference in July 2009

Results Overwhelming support from phototherapy staff for development of a professional forum

Development of the network The Network was established in 2008 by St John’s Photodermatology Unit. Phototherapy units in London and the South East of England were invited to join. Open to all health care professionals involved in provision of phototherapy services  Nurses  Physiotherapists  Medical physicists  Dermatologists

Development of the network Afternoon meetings set up three times per year Focus of meetings to provide:  Presentations by clinical experts  Evidence based practice  Professional networking and support Telephone and advice available Development of a website

Meetings so far We have now held 15 meetings since December nd : 2nd April rd : 3 rd October th: 4 th February 2010 We have since held 3 updates per year, in February, June and October

Network Programmes:- 1 st meeting Introduction to the Phototherapy Network and presentation of audit results Nichola Mair, Network Project Coordinator. Question and answer session Evidence based phototherapy practice, with reference to MED/MPD’S and protocols Trish Garibaldinos Clinical Nurse Specialist Light induced dermatoses – where does Phototherapy fit in? Dr Robert Sarkany Consultant Dermatologist & Director of Photodermatology

4 th Update- feb 2010 Photo Immunology Dr Susan L Walker, Phototesting Coordinator, Photodermatology St John’s Institute of Dermatology, St Thomas’s Hospital Pharmacology of Psoralens and Potential Photosensitisers Maria Eagle, Senior Specialist Pharmacist, Dermatology and Allergy St Thomas’s Hospital Difficult Case Scenarios Jenny Anthony,Dermatology Nurse Practitioner, Homerton University Hospital

In February 2011 we began to make the transition from a Support Network into a Managed Clinical Network for Phototherapy

This involved:- 1. Setting up a Steering Group, with elected members to ensure that all colleagues in the network were fairly represented 2. Agreeing on minimum standards for all aspects of phototherapy, equipment maintenance, staff training, protocols, patient information etc, which are regularly reviewed. 3.Regular auditing ourselves to see whether our own units are meeting the standards and problem solving where we are not.

Re audit Mid 2011 we re audited all member units against the new Network Standards We used the 6 sections from our original audit and asked similar questions, so that direct comparisons to the first audit could be made Also expand and go into more detail within each section

Data Collection Spreadsheet questionnaires were sent to all member units by to lead phototherapists

Key Points There are on average 3 machines per unit. All units provide NBUVB, and 78% offer PUVA (total body and hand and foot) Phototherapy is administered by dermatology nurses in 88% of units

Key Points 46% of machines are 5-10 years old 2% are over 25 years old! ( but well maintained!) 26% of units do not have a lead consultant 54% of units have yearly servicing

Key Points 56% of units have trust-approved treatment protocols 50% of units do not have access to medical physicists Phototherapy is initiated by skin type for PUVA in the majority of units, but by MED for UVB

Key Points 98% of all units are calibrating their machines, 2% did not answer. 2% of units may have questionable output 6% of units do not know the output from their machines

Comparison with our Audit NBUVB 100% 100% BBUVB 22% 38% PUVA 78% 85% Derm nurses 88% 97% Physio’s 12% 3% Bath PUVA 50% 45% Consultant 74% 75% Med Physics 50% 50% Protocols 94 % 95%

Comparison with our Audit 2008 In 2008, only 28% used MED alone for UVB In 2011 this had risen to 66% In 2008, only 8% of units used MPD alone to initiate PUVA. In 2011 this had risen to21% In 2008, only 80% of units calibrated their machinery. In 2011 this had risen to 98%

Sharing information The results of this audit were presented at: BDNG Phototherapy day conference in Harrogate in April Photonet Annual Day Conference at Perth Royal Infirmary in May 2012

Re audit No 3 We have since carried out a further audit, in June of this year and hope soon to be sharing the results of this in the next few weeks.

Membership 2013 Current membership Hospital Trusts 65 phototherapy units

Discussion