Ingrid Torjesen reports on an award winning teledermoscopy service that escalates routine dermatology referrals from GPs to secondary care management
A teledermoscopy service, which picks up routine dermatology referrals from GPs that would otherwise have been seen in secondary care, received the Improving Care with Technology award in the 2017 HSJ Awards.
The service is run by Communitas Clinics for Surrey Downs Clinical Commissioning Group and last year saved the CCG £388,000 on dermatology services by enabling the vast majority of referrals to be managed in primary care.
It also escalated around one in 10 patients referred to it as a routine case to secondary care management because the service’s doctors suspected they may have a more serious condition. As a result, these patients were seen far more quickly than they would have otherwise been without the service as they would have had to wait for a routine secondary care appointment.
How it works
Under the service, GPs continue to refer suspected cancer cases to secondary care under the two week urgent pathway, and most other cases, except for high risk cases, such as suspected basal carcinomas, are fed into the teledermoscopy service. The GPs provide pictures of the condition with their referrals and are able to suggest a potential diagnosis to aid their learning in dermatology.
However, most GPs commonly refer lesions saying they do not think the lesions are cancerous but are not sure of the diagnosis, explains Anna Bernard, business development manager at Communitas Clinics. “They are essentially referring it into us to get a diagnosis and management plan.”
The images are sent along with the patient’s history and the clinic’s doctors review the cases and send the GPs a provision diagnosis and management plan
Bespoke technology for the service was designed in collaboration with GPs, commissioners and local trusts and enables GPs to make real time referrals with images (dermatoscopic photographs) to the service’s doctors.
The images are sent along with the patient’s history and the clinic’s doctors review the cases and send the GPs a provisional diagnosis and management plan.
“GPs then essentially look at that information side-by-side with the images, so for every case they get learning feedback,” Ms Bernard emphasises.
The tariff for the teledermoscopy service is £49 compared with £159 for the local outpatient dermatology service, and last year (2017-18) Surrey Downs CCG reduced its dermatology spend by £388,000 in 2017-18 compared with the previous year by using the teledermocopy service.
Provision of i-pods, dermatoscopic attachments and training to each practice in the CCG cost a one off £600 per practice, and running the interactive referral platform, including the support line for the area’s service, costs £21600 per year.
“In reality, £49 is not enough to run a dermatology service so we were running at a slight loss,” Ms Bernard admits. “We are about breaking now because the referrals have increased.” But the tariff will need to rise slightly in future to ensure the service runs at a small profit and is sustainable, she adds.
Last year, the teledermoscopy service received 712 referrals – 13 per cent of which were then referred to secondary care under the two week urgent suspected cancer pathway and another 1.5 per cent cases (such as high risk basal cell carcinomas) were also referred to secondary care.
Satisfaction levels with Surrey Down’s teledermoscopy service are high with 89 per cent of referrers saying they would recommend the service to a friend or colleague
“The remainder either didn’t need treatment at all because they were benign, or they were successfully managed in primary care or within the local minor surgery services within primary care,” Ms Bernard says.
The implementation has been staggered to ensure practices starting to use the system receive maximum support.
At the moment, 68 per cent of practices in the area are referring to the teledermoscopy service, and another 12 per cent have agreed to participate and are booked in to receive training in how to use it.
Eight clinical commissioning groups have expressed an interest in running a similar service in their areas, and two of these are likely to begin pilots shortly.
Satisfaction levels with Surrey Down’s teledermoscopy service are high with 89 per cent of referrers saying they would recommend the service to a friend or colleague, and 88 per cent saying that they felt the service had enhanced their dermatology knowledge. Meanwhile, 100 per cent of patients said they would recommend the service to family and friends.
What the judges said
The HSJ judges said: “There were very strong clear benefits for patients and providers and commisssioners and very good use of technologies.”