Description

It will not come as a surprise to our readers that the forces of change are at work in the organisation of the NHS. With the advent of specialised commissioning, there will be tremendous change in the way in which our laboratories and clinics are funded. Those of us practising Immunology and Allergy will have to come to terms with three new definitions of specialised services. In the last issue, we presented the new definition of Specialised Immunodeficiency Services. In this issue of CPD Bulletin in Immunology & Allergy we have reproduced the definition of Specialised Allergy Services, and in a future edition we will distribute the definition of Specialised Immunology Laboratory Services, once the definitive version has been published by the Department of Health.

All three documents represent a great deal of discussion and debate, and will no doubt generate much more. Many practitioners will wonder how they managed to provide a service at all once they see some of the elements of practice outlined in these documents. Policies of perfection are all very well when infinite time and resources are available with which to implement them. But the real world is not like that. Many of the specialised services outlined in these definitions have been, and continue to be provided by well-trained and appropriately skilled practitioners around the country, although often in centres which are severely under-resourced. In these days of severe difficulties in recruiting to Immunology and Allergy, it is vital that Immunologists and Allergists do not feel disenfranchised by these proposals. Specialists have special skills – and continue to develop these long after their official training period is over; failing to recognise this, and enforcing limitations on practice by starvation of resources will be counter-productive.

As seen in the Government’s plans for Pathology Modernisation, there are ways in which we can make positive progress. The emerging concept of ‘Managed Networks’ is a real attempt to solve some of the difficulties facing single-handed practitioners in Immunology and Allergy. Combining elements of decentralisation, joint decision-making and risk sharing, the Managed Network may be a way forward for the development of comprehensive Immunology and Allergy Services without making existing specialists feel decidedly unspecial.

Acknowledgement

The Editorial Board is grateful to Grifols UK and ZLB Bioplasma UK Ltd for help in financing this Bulletin.

Carrock Sewell
Associate Editor