Introduction

Foreword/statement of support

Specialist and Advanced Specialist Practice is an essential part of the Nursing workforce within Dermatology and has a key role in Boards of every size and geography in Scotland. Indeed, it is almost impossible for most of us involved in Dermatology in 2025 to picture Dermatology services without Specialist Nurses and the contributions they make.

This framework (which was proposed and ultimately endorsed by the National Dermatology Specialty Delivery Group) provides a consistent approach to the specialty specific competencies at level 6 and 7 Dermatology Nursing. It is hoped that the framework will provide a model to underpin future training, work-based learning, appraisal, and personal development for Specialist Dermatology Nurses in future. Furthermore, the framework is intended to support service development and team service planning to highlight the potential that Specialist Nurses have to offer Dermatology services and to maximise the benefit we receive from these valuable staff and that this is supported by appropriate funding.

Working on competencies at a national level presents challenges and some warranted variation will persist. The day-to-day work of a Specialist Nurse in an island or rural service will still be different from that in a big city hospital. However, establishing core competencies at a national level supports training, supervision and recruitment, and enables Boards to support one another in the development of skill mix appropriate to their local situation.

We strongly welcome this framework and will be encouraging its adoption by all Health Boards for the purposes outlined above.

Fiona Macdonald, CfSD National Specialty Advisor and Chair Dermatology SDG
Gav Dolan, CfSD National Associate Clinical Director (Nursing)

Introduction

Focus of framework

Clinical Nurse Specialists (CNSs) are registered Nurses who practice at level 6 and above within Dermatology. They are a crucial part of the multi-disciplinary team, providing expertise in a number of areas including, but not exclusive to, diagnosis, treatment, and ongoing support and advice for patients with skin conditions in Scotland.

The Scottish Government’s Chief Nursing Officer Directorate published the Transforming Nursing Roles paper 8 (TNR Paper 8) in August 2021. This outlined that there is clear demarcation of roles for CNSs across Scotland, and job titles are often not aligned with clear education pathways and provisions.

To address this, this framework will promote a national approach for advanced nursing within Dermatology, providing structure for the knowledge and skills that are required. The framework is aligned with TNR Paper 8 and recognises that additional sub-specialist competency requirements will be decided at the local level depending on service needs.

Aim and outcomes

The Framework for Specialist Nursing in Dermatology aims to articulate the knowledge and skills required to provide high quality Dermatology services. The framework is intended to be used by healthcare practitioners, managers, and educators to understand and develop knowledge and skills across four pillars of practice. The framework is aligned to Career Framework for Health model and the NMAHP Development Framework. The framework, however, focuses on levels 6 and 7 on the grounds that levels 2 to 5 will be covered by generic competencies.

The outcome and impact of using the framework:

• Describing the knowledge and skills required within the service - the framework can be used by individuals developing their current and future practice; organisations reviewing or developing their services for their local populations; and educators ensuring knowledge and services meet the needs of the service.
• Providing Career Pathways – the service is an emerging service offering new and exciting career opportunities for healthcare practitioners. The framework enables individuals and their managers to explore knowledge and skills required to enable them to benchmark their knowledge and skills and prepare for career progression within services. This service opens opportunities for individuals who aspire to horizontal or vertical career progression.
• Recruitment and Succession Planning - organisations developing their services can use the framework to help define the knowledge and skills required for current and future services in Scotland. Consideration of service models in other areas that may be transferable to their own service. Recruiting the right people who aspire to develop their careers within the service can provide a succession plan.

Background and strategic alignment

This framework has been co-produced by NHS Education for Scotland (NES) and the National Dermatology Specialty Delivery Group (SDG). The SDG includes nominated representatives from all Health Boards in Scotland (in particular a Clinical Lead, Operational Management Lead and Nursing Lead). In advance of the development of the framework, the SDG undertook a service needs assessment in which all Health Boards were invited to respond with regards to their current Dermatology Specialist Nurse workforce (including current workforce, bandings, and priorities for training and development).

The Needs Assessment highlighted the importance of the Specialist Nursing workforce in Dermatology services and the fact that in most cases the Specialist Nurses were seeing patients independently. From the Needs Assessment it was clear that 9/10 Health Boards wished to increase the number of Specialist Nurses employed in Dermatology and the key priorities were succession planning for the existing workforce and increasing the number of return patients who could be seen by Specialist Nurse roles. Following the feedback from the needs assessment the SDG agreed to undertake a coordinated programme of work in relation to Specialty Nurse roles, the first step of which was to develop this national competency framework.

A small task and finish sub-group was formed to undertake the work. This group included representatives from Boards of various sizes and geography to ensure that the framework could work nationally. The group was co-chaired by the CfSD National Clinical Lead for Dermatology and the CfSD Associate Clinical Director for Nursing. A Senior Educator from National Education for Scotland provided specialist input from an educational perspective. The final framework was brought to the SDG for approval to ensure buy-in from all Health Boards.