title: The south-east Scotland dermatology workload study: 30 years' analysis.
abstract: BACKGROUND
  Dermatological activity data have been collected for the same region of south-east Scotland (population 1·24 million), approximately every 5 years, since 1981. This has allowed assessment of trends in demand from primary and secondary care, and activity within secondary care dermatology services, assisting planning of dermatological services.
  
  
  OBJECTIVE
  To quantify dermatology outpatient workload across the same population to allow comparison with previous studies for trends in practice.
  
  
  METHODS
  During November 2010, a standardized proforma was completed for all National Health Service and private practice dermatology outpatient consultations. Demographic data, source and reason for referral, diagnoses, investigations, treatments and disposal were recorded, and comparisons made with five previous studies.
  
  
  RESULTS
  A total of 5470 consultations were recorded: 2882 new and 2588 review patients (new to review ratio 1 : 0·9, male to female 1 : 1·3, mean age 49 years, range 1 month to 101 years). Ninety-one per cent of referrals came from primary care and 9% from secondary care. Fifty-eight per cent of referrals were for diagnosis and 32% for hospital management. Diagnostic concordance between referrer and dermatologist ranged from 94% for acne to 14% for melanoma. Benign tumours accounted for 30% of referrals, malignant tumours 13%, dermatitis 13·3%, psoriasis 6·2% and acne/rosacea 5%. The referral rate rose to 23·2/1000 population per annum, with the increase coming mainly from primary care.
  
  
  CONCLUSIONS
  Demand for dermatology continues to increase: new referrals have risen by 134% in 30 years, with a 36% increase in the last 5 years, despite corresponding population increases of 5·3% and 3%, respectively.
authors.affiliation: Department of Dermatology, Royal Infirmary, Lauriston Buildings, Lauriston Place, Edinburgh EH3 9HA, UK. alex.holme@nhs.net
authors.forename: S A
authors.initials: SA
authors.lastname: Holme
authors.forename: V E
authors.initials: VE
authors.lastname: Scott-Lang
authors.forename: E T
authors.initials: ET
authors.lastname: Ooi
authors.forename: A G
authors.initials: AG
authors.lastname: Matthews
authors.forename: M I
authors.initials: MI
authors.lastname: Darling
authors.forename: D
authors.initials: D
authors.lastname: Needham
authors.forename: S K A
authors.initials: SK
authors.lastname: McCormack
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011331:Private Practice / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012606:Scotland; D012871:Skin Diseases / Q000175:diagnosis / Q000628:therapy*; D013222:State Medicine / Q000706:statistics & numerical data; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data; D014850:Waiting Lists; D016526:Workload / Q000706:statistics & numerical data*; D055815:Young Adult