How to book a dermatology appointment for your eczema child

If you are in the UK and your child has eczema, it is likely that this was diagnosed by your GP following the NICE guidelines. The National Health Service provide free healthcare to UK residents. However, it is currently over-stretched and waiting times for appointments are frustratingly long. As a result, many parents feel that paying to ‘go private’ is their only option. We look at the process of booking both NHS and private dermatology appointments for your child and consider the pros and cons of going private.

• GPs are well supported by clear NICE guidelines and can treat most cases of childhood eczema successfully. Larger practices will often include a GP with special interest (and extra training) in skin conditions.
• When GPs aren’t able to manage eczema adequately, they can make a referral to specialist dermatology and allergy services. The NICE guidelines outline various criteria for referral including severe eczema that has not improved within 1 week of treatment and moderate eczema that has not improved within 1-2 weeks of treatment.
• While referrals made through the NHS are free, waiting times can be long and frustrating. By going private you typically be seen much faster. However, private medical appointments can incur significant costs even if you have existing medical insurance as most policies have an annual excess.
• Some private providers require a referral letter from your GP. Others may accept your request for a dermatology appointment without one.
• It’s useful to be aware that the NHS follows an established process for record keeping. Your child’s medical history and notes will be universally available across all departments. While private consultants will write to your GP, there is no guarantee that this information will be added to your child’s digital medical records.

Dermatologist appointments through the NHS

GPs are well supported by clear NICE guidelines¹ and can treat most cases of childhood eczema successfully. If the eczema is straightforward and your child responds well to the mainstay treatments of emollients and occasional cortisones, you need read no further.

For those of you still reading it is likely that you feel that the solutions offered by your GP are not solving the problem and you want to see a specialist skin doctor. Booking NHS dermatology appointments is not as straightforward as booking GP appointments as you will need to get a referral first. GPs can only make referrals when they are exhausted the standard treatments laid out in the NICE guidelines or other criteria have been met. You can find our more about navigating eczema treatment on the NHS here.

What is a referral?

According to the General Medical Council (GMC) “Referral is when you arrange for another practitioner to provide a service that falls outside your professional competence.“

In other words, a GP referral is to see another healthcare professional for specialist tests, treatment or care. Whilst it is typically doctors who issue referrals, nurses and other healthcare staff may be able to provide one too.

Typical reasons for referral include:

• eczema is severe and has not responded to optimal topical therapy after 1 week
• moderate eczema not responding well to standard topical treatments. For example, 1 to 2 weeks of flares per month or adverse reaction to multiple emollients
• infected eczema not responding to treatment
• persistent facial eczema
• if contact allergic dermatitis suspected e.g. persistent atopic eczema or facial, eyelid or hand atopic eczema
• eczema is giving rise to significant social or psychological problems for the child, parent or carer e.g. sleep disturbance, poor school attendance

You should expect a discussion with your GP about their reasons for referring your child and any tests or treatments which they are recommending. You may be given a choice of where you go and who you see, although this is dependent on your local services.

On the plus side NHS dermatology appointments are free. However, waiting times can be long. Furthermore, the process of trying all the front-line treatments through your GP first in order to be eligible for a specialist appointment can be time consuming and frustrating if you find them all to be ineffective.

Going private with insurance

If you have private healthcare insurance cover which includes your child, you may be able to speed up the appointment process. Some providers require a referral letter from your GP. Others may accept your request for a dermatology appointment without one. The advantage of going through an insurer is that they will have a list of suitable hospitals and clinics. They will also be able to guide you through the process of finding the right dermatologist for your child and booking the appointments.

Whilst you will typically be seen much faster than with the NHS, private medical appointments can incur significant costs even if you have existing medical insurance as most policies have an annual excess. However, you may be able to access more expensive treatment options sooner than you could with NHS care.

Booking directly with a private dermatologist

The third option is to make a direct appointment with a private clinic. You will need to research the clinic and the practitioner carefully to ensure they are suitable. Not all private clinics accept patients under the age of 18. It’s worth making an initial enquiry call to their receptionist before you do anything else. Most private clinics will charge a basic consultation fee just to make the appointment.

Things to consider when choosing a private clinic

• Do they accept babies and children as patients? This is actually an insurance issue for the clinic so don’t take offence if the answer is no.
• Is the clinic CQC qualified? The Care Quality Commission is an independent regulatory service that oversees healthcare providers (a bit like OFSTEAD for schools). It is not mandatory to be CQC registered, however it is a strong indicator of excellence so an excellent reference.
• Do they accept patients through the big health insurance providers like BUPA and Nuffield Health? If they do this means they are preferred providers for these companies and therefore you can be assured that they are legitimate.
• Type of appointments offered (face to face or remote). Remote appointments not recommended by the NHS for initial consultations and are only deemed suitable for follow-up appointments in limited circumstances².

If you are unsure, check the medical register or search the doctor up online. You will commonly find that private consultants also do NHS work.

Record keeping

The NHS follows an established process for record keeping. Your child’s medical history and notes will be universally available across all departments of the service for both viewing and updating.

However, if you do go down the private route, the consultant usually won’t have access to your child’s medical records. You may need to request that a copy of these are sent to the consultant. Details of private treatments should be sent to GP in form of a letter, but this information may not make it onto your child’s digital records. It’s wise to let your GP know about any private medical treatments when you next see them. This means you can be sure that they have received and recorded the details correctly.

Next steps

Once you have made your appointment, whichever route you decide to go down, you will need to take some time to prepare your questions and concerns in order to maximise the time you have. You may find our post on getting the most from your child’s dermatology appointment useful.

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1. Overview | Atopic eczema in under 12s: diagnosis and management | Guidance | NICE
2. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/04/B0502-setting-up-remote-consultation-services-for-people-with-skin-conditions.pdf

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