Organisation develops a real time referral service to provide timely diagnosis and management plan for skin cancer patients, reducing unnecessary referrals to secondary care

Challenges

 This solution supports GPs in the management of skin lesions with diagnostic uncertainty. Bespoke store and forward technology was designed and utilised to enables referring GP colleagues to send real time referrals and images (dermatoscopic photographs) to qualified clinicians and receive timely diagnosis and management plan for patients.

This solution drew on the following best practice:

•BAD’s quality standards for teledermatology

•NHS England QIPP paper: NHS Bristol teledermatology

•NICE: Improving outcomes for people with skin tumors including melanoma (update).

 A staggered implementation was adopted following consultation with GPs, commissioners and local trusts ensuring maximum support was provided during mobilisation.

Actions

 Referral software was tailored following consultation with GPs, commissioners and local trusts to ensure a seamless, interactive platform for referral which provides real time communication between referrer and dermatology specialist. Patient engagement during service design identified a need for self-management promotion, patient education and improved access to services. This technological solution provides truly equitable access regardless of location or mobility and provides individualised educational reference for both patients and GPs.

 Consistent collaboration from vantage referral management, Communitas Clinics, commissioners and GPs ensured that the design of this solution meets clinical and information governance best practice. All staff within the mobilisation team, including software developers, communitas senior managers, information governance steering group, clinical governance committee, senior administrators and commissioners were involved in the design of this solution with allocated ownership for milestones throughout implementation. Standard operating procedures and guidelines were produced to ensure overall consistency and a seamless implementation. Installation and training visits included bespoke review of individual practices, ensuring that this solution is fully integrated with each practice’s system and processes. Commissioned expected 9 participating practices by the end of year 1, success of implementation is demonstrated with 19 practice fully participating by month 4.

 A single point of access for technical and referral support was established to ensure easy access for referrers and speedy solution to potential issues. A strong partnership has been maintained between Communitas Clinics (provider) and vantage referral management (vendor) from the outset of this solution. Collaborative design and implementation has forged this relationship and dedicated solution managers meet monthly to measure implementation and support functions against a robust, locally defined service level agreement. A dedicated technical support line is delivered as part of the above SLA where 24 hour support is available to referring GPs and provider staff alike. The following costs were incurred by Communitas Clinics as part of solution set up:

•Ipod, dermatoscopic attachment and training was provided to 19 practices in Surrey Downs during mobilisation with a one off cost of £600.00 per practice.

•Interactive referral platform, including support line, with an annual cost of £21600.00. The tariff per teledermoscopy referral is £49.00 payable on invoice by Surrey Downs CCG. 42% of patients referred to the teledermoscopy service have avoided a referral to secondary care. With local dermatology outpatient tariffs of £159 – this represents an NHS saving of £109 for each of these patients. Please see tariff breakdown attached as appendix 1.

Results

 Reducing unnecessary referrals to secondary care: 42% of patients have been successfully managed in primary care following Teledermoscopy advice, who would otherwise have been referred to secondary care

 Improved skin cancer outcomes: 10% of patients routinely referred, have been escalated to an urgent suspected cancer pathway following teledermatology referral. These patients would otherwise have waited 13 weeks – reducing RTT by 88 days.

Satisfaction

•89% of referrers would recommend this service to a friend or colleague

•88% of referrers feel using this service has enhanced their dermatology knowledge

•100% of patients would recommend this service their family and friends

Spread

 This solution has been adopted throughout our organisation with dermatoscopic images being used during clinical consultation; aiding treatment decisions and clinical continuous professional development.The outcomes of this solution have been shared with Croydon and Bexley CCGs who are both considering a pilot. Future technical implementation is achievable remotely, requiring only physical attendance for equipment training. A train the trainer program has been developed which could impart this knowledge quickly and efficiently beyond local boundaries. Due to the remote clinical access required to safely deliver this innovative solution to dermatological advice, this solution could be applied anywhere in the UK.