Autumn 2017

Staff Newsletter

Photonet National Managed Clinical Network

Things to remember when using Photosys to

ensure data is entered correctly Postcode- An up to date and accurate postcode should be entered for ALL PATIENTS.

Erythema - This should be entered for Grade 3/4 painful erythema episodes only.

Type of Phototherapy Treatment - Please ensure you select the correct type of treatment for your unit, eg UVA1 is currently only a treatment option in Tayside and Greater Glasgow & Clyde.

Diagnosis - Please ensure that only one diagnosis is entered against a course of treatment. If a patient has more than one skin condition please choose the primary diagnosis. Entry of more than one diagnosis results in duplicate courses being reported from Photosys.

Referral Date - Please be careful when entering the referral date.... we recently had some patients waiting over 20,000 days to start treatment!

Number of treatments - Again, please be careful when entering the number of treatments..... we recently had a patient who was added as having 1,555 treatments for one course of UVB phototherapy given over 3 months!

Photonet Website In the recent weeks Photonet website has been updated which has resulted in a slightly different look and navigation. If you wish to find latest protocols, reports and in-formation regarding Photonet Steering Group meetings this can be found on the Home page, scroll on the right hand side to find the ’Professionals Area’ and press ’Read more’ to access all of the above and more! If you have ideas how we could improve the web-site and what would find useful to be made avail-able please do not hesitate to get in touch with Photnet office on nss.photonet@nhs.net

Photonet Annual Meeting The Network hosted its 15th Annual Photonet Meeting on 25 May 2017

This year’s annual meeting was well attended by clinicians from across Scotland and beyond—thank you to the network members who came along and helped to make it such a successful day. Karyn Robertson (Senior Programme Manager, NHS NSS opened the meeting with with an update on Photonet National MCN Review followed by Dr Robert Dawe Lead Clincian update. The day also included presentations from Kevin Campbell ‘Photonet Equipment Audit’ and James Thom Photonet Dashboard. Special thanks to this year’s keynote speaker, Professor Erna Snelmann who travelled from Finland to provide very interesting talk on Heliotherapy.

Thanks also to our colleagues who facilitated our workshops this year: Ewan Eadie, Paul O’Mahoney, Sarah Butt, Linda Malcolm , Lynn Fullerton, Laura Patullo, Joanna Campbell, Robert Dawe, Karyn Robertson & James Thom.

16th Annual Meeting— 24 May 2018, venue to be confirmed.

If you have any educational issues you would like to see covered at the annual meeting please let us know. Also, please consider providing a short case study for discussion at next year’s meeting to facilitate shared learning. Further information regarding this meeting will be circulated in the New Year.

The current membership of the group includes: Robert Dawe, Network Lead Clinician Mhairi Gallacher, Programme Manager Aneta Gorczynski, Programme Support Officer Liz Callan, Phototherapist Joanna Campbell, Phototherapist Kevin Campbell, Photonet Technician Fiona Craig, Consultant Dermatologist Una Donaldson, Dermatology Nurse Lynn Fullerton, Senior Clinical Technician Gill Keber, Phototherapist Louise MacFarlane, Consultant Dermatologist Karne McBride, Principle Medical Physics Technologist Helen McKendrick, Phototherapist Ruth Ray, Associate Specialist Sheena Russell, Consultant Dermatologist Nick Wainwright, Consultant Dermatologist

Steering Group Update

The Photonet Steering Group consists of mem-bers from across the spectrum of stakeholders in Scotland and includes Phototherapists, Con-sultant Dermatologists and Medical Physics representation. The group meets around four times and year. If you would like to become involved in the work of the Steering Group in the future we’d be delighted to hear from you. Minutes of steering group meetings are avail-able on the website and if you have anything you would like discussed by the Steering Group please contact Mhairi at the Network Office.

Photonet Dashboard

James Thom, Data Manager for Photonet, has been working with the Steering Group members to develop a Dashboard using data from Photo-sys. The Dashboard was presented at the annual meeting in May and since that meeting further changes have been made.

The Dashboard will allow those working in individ-ual phototherapy units to look at their own up to

date data and to compare how they are doing in relation to other centres throughout Scotland. In particular, this will assist centres in identifying the effects of any changes in practice intended to im-prove aspects of phototherapy.

We look forward to circulating details of how to find and use the dashboard as soon as it

has been finalised.

Annual Phototherapy Unit Audit Reports 2015/16

Lead Nurses and Lead Consultant should by now have received their draft phototherapy unit reports for 2015/16. The development of the dashboard will greatly assist with more timely reporting of data to units in the future.

Apologies for the delay in issuing this year’s re-ports.

The self audit forms have also been issued to allow the network to gather the information re-quired to report on the outcomes for the 2016/17 annual audit. Thanks to all the staff involved in completing and returning the annual audit documenta-tion.

2016/17 Annual Audit

One of Photonet’s objectives is that the network promotes equity of access to phototherapy services in Scotland.

Over 50 skin diseases are sometimes treated with phototherapy and more than 5 of these indications (including the two most frequent indications, together accounting for about three-quarters of courses, for phototherapy in Scotland, psoriasis and atopic eczema) are supported by good randomised controlled study evidence. The majority of conditions treated with phototherapy are inflammatory disorders, although it is also used for other conditions such as the mycosis fungoides form of T-cell lymphoma. When considering treatments for conditions we always have to consider the chances of the treatment being beneficial weighed against definite and possible risks. We also need to consider costs – when one treatment (for example adalimumab for psoriasis) costs >£18,000 in drug cost alone then if this treatment is used when instead of a phototherapy this is indirectly denying other patients from having treatment. There is evidence that phototherapy reduces the requirements for other, including more costly, treatments. The main practical consideration regarding equity of access to the phototherapies relates to access to equipment and a framework (including trained phototherapists delivering the treatments or supporting patients in self-treating as well as medical physics involvement to ensure accurate dosimetry and equipment safety) to deliver these treatments. There are different ways of providing phototherapy – some phototherapies such topical PUVA can be potentially dangerous if not supervised particularly closely and is always used as a hospital delivered treatment whereas other phototherapies such as narrowband UVB and localised oral PUVA can be delivered, for selected patients, at home.

The most widely used phototherapy is narrowband ultraviolet B although it is important to keep in mind that other phototherapies, particularly PUVA, remain important for those with conditions that cannot be treated with narrowband ultraviolet B and for individual patients for whom narrowband ultraviolet B has not worked adequately. In order to allow ready access to narrowband ultraviolet B for as many people as possible who would benefit from it we need to consider: 1. number and geographical spread of hospital based phototherapy units; 2. the availability or otherwise of self administration hospital, or other centre, based units; 3. home phototherapy services; 4. the opening hours of hospital-based units. In Photonet we have discussed in a short life working group issues regarding equity of access to phototherapy. Because of the differences between different geographical areas and how services work in those areas it seems appropriate that the precise mixture of different ways of improving access is decided locally rather than nationally. Through Photonet we can, in particular, try to help with local initiatives to increase access (such as by improving opening hours, opening new units and setting up home phototherapy services). Photonet works with centres looking to expand phototherapy availability for their patients by providing data to support business cases. The network also plans to work with a health economist to develop an economic case for phototherapy to assist with expansion of services across Scotland. If your centre would like to discuss how Photonet can help with equity of access in your area please get in touch.

Equity of Access to

Phototherapy in Scotland

New Phototherapy Units—Update

Crieff Community Hospital UVB Phototherapy opened in July 2016 supported by staff from the Mi-nor Injury Unit. To date over forty patients have received treatment which equates to around 1,200 visits. This new unit is very convenient for patient and is a huge saving for them both in time & travel.

Pitlochry Community Hospital will commence deliv-ering UVB phototherapy in September 2017. Three patients are ready to start treatment and trained staff will provide a local convenient UVB Phototherapy Service for patients from Pitlochry and the surrounding area.

To capture patients who would otherwise not be able to attend either Ninewells Hospital in Dundee or Stracathro Hospital in Angus due to lack of trans-port or work commitments there has been a require-ment for a UVB cabinet in Arbroath. As the space in Arbroath Infirmary is very limited, a small whole body phototherapy cabinet (as used for home phototherapy) was purchased for patients to self treat, when appropriately trained by the Stracathro phototherapists.

The first patients to administer their treatment under supervision took place on 30 August 2017.

Arbroath Infirmary

Crieff Pitlochry

HMP Glenochil

Golspie

HMP Glenochil — The first patient was treated with UVB Phototherapy at Glenochil Prison in November 2016.

Photonet is in discussion with a further two Health Boards regarding the possible development of new phototherapy cen-

tres in their area.

A new phototherapy service has been in operation at the Lawson Memorial Hospital since August 2017. The unit offers UVB phototherapy for pa-tients who until now had to travel a 100 miles plus round trip for treatment in Inverness. The move will benefit some of the several hundred people a year. Specialist nurses Eileen Martin and Lindsay Macleod will run the unit. Dr Louise Macfarlane, consultant dermatologist at Raigmore, said: “The new UVB phototherapy service at Lawson Memo-rial will significantly improve access to treatment for people in Sutherland and Caithness, and re-duce travel times as it will now be offered closer to home.”

Coming Soon......

We are in the final stages of the development for the new online learnpro course. We will circulate details as soon as we go live! In the meantime, you can still register and

complete the current course at:

http://www.photonet.scot.nhs.uk/elearning-course/

Updated Documents

Photonet Referral Form & Photosys Patient Information Leaflet A small number of changes have been made to the Photosys Referral form and Photonet Pa-tient Information leaflet. Please ensure your unit is using the most up to date versions of these documents. Links can be found below. The Photonet Photosys referral form contains all the fields for information required to be en-tered into Photosys however individual centres may wish to adapt the form for their own centre, eg adding option for UVA1 where this is avail-able. Word versions of the forms are available on the website which can be adjusted as re-quired. Photosys referral form Photosys Patient Information Leaflet

Please remember that the referral form should be signed by (or on behalf of) ALL patients, after they are provided with a copy of the Photonet In-formation Sheet, a copy of which should also be given to ALL patients as it provides them with information on how their data might be used. Role of Network Lead Clinician Robert Dawe’s term as Lead Clinician for the Network was extended until 31 March 2018. If you are interested in this position or would like to find out more, Robert would be pleased to have an informal chat about what’s involved in the Lead Clinician role. The process for formally ad-vertising this vacancy will start beginning of the New Year to hopefully allow for a period of hand-over.

Contact Us NSS.photonet@nhs.net www.photonet.scot.nhs.uk Tel: 01382 425695

Mhairi Gallacher Aneta Gorczynski Programme Manager Programme Support Officer