Glan Clwyd Hospital (Welsh: Ysbyty Glan Clwyd) is a hospital in Bodelwyddan, Denbighshire, Wales. It is managed by the Betsi Cadwaladr University Health Board...
Introduction of the statutory process of independent medical scrutiny in England and Wales, provides an excellent opportunity to identify shortfalls, concerns and helps us to learn from deaths. The system adopted by Wales (in contrast to England) guarantees fully independent scrutiny as recommended by the confidential enquiries into deaths. Evidence shows that a significant proportion of deaths has been referred to the care providers for a clinical review and to improve patient care. However, the system has created so many steps in the death certification process it leads to delays in issuing death certificates causing distress and anguish to the bereaved families. A multipronged approach to streamline the death certification process should include: education and training of doctors, a prompt, proportionate and pragmatic scrutiny by MEs, a review of the criteria for referral to coroners, implementation of digital MCCD and an overhaul of the list of causes of death.
Periorbital and pedal plaques in a young diabetic woman demonstrate granulomatous inflammation, prompting diagnostic uncertainty and highlighting the value of clinicopathological correlation.
Abstract The NHS faces mounting financial pressure, with medicines expenditure reaching £19.9 billion in 2023–24. Cost awareness among prescribers is an important but underexplored determinant of sustainable prescribing. Between April and June 2025, an audit identified the most frequently prescribed dermatological medications in one UK region: lymecycline, mometasone furoate 0.1% w/w cream, adapalene 1 mg (0.1% w/w) and benzoyl peroxide (2.5% w/w) gel, prednisolone, isotretinoin, acitretin, methotrexate and trimethoprim. An electronic survey assessing drug-cost awareness was distributed to dermatology physicians across the UK. Of 178 respondents, 116 (65.2%) were consultants and 62 (34.8%) were junior doctors; 113 (63.5%) were female and 65 (36.5%) male. Among consultants, 47.4% (n = 55) worked exclusively in the NHS, 44.0% (n = 51) undertook combined NHS and private practice, and 8.6% (n = 10) were solely in private practice. Cost awareness was limited: 47.2% (n = 84) reporting partial awareness and 25.8% (n = 46) had none. Overall cost identification accuracy was 37.7%, lowest for trimethoprim 200-mg tablets (25.8%). Only 1.1% identified all costs correctly, while 6.7% answered all items incorrectly. Accuracy was highest among consultants solely in private practice (59%), compared with NHS only (38%) or mixed practice (39%). Most respondents considered cost awareness as somewhat important (62.3%) or extremely important (30.9%). Participants anticipated that displaying drug costs within electronic prescribing would somewhat influence decisions (61.8%), strongly influence decisions (19.1%) or have little or no impact (19.1%). This first UK-wide study highlights substantial gaps in dermatology clinicians’ awareness of costs of commonly prescribed treatments, with greater knowledge among private practitioners. Enhancing prescriber cost literacy and embedding cost information into electronic prescribing may support value-based decision making and NHS financial sustainability. Integrating cost-awareness training into dermatology curricula represents a feasible strategy to address this need.
