Summary
The consultant dermatologists at Sussex Community Dermatology Service, with significant experience and backgrounds in healthcare economics, decided to seek a solution to long patient waiting times and a consultant shortage of over 100 posts nationally. They engaged with patients, GPs, consultants and CCGs to develop the digital health solution, ‘MySkinDoctor’. MySkinDoctor is an online, patient-led mobile app which allows patients to access dermatology services remotely without the need to visit a clinic. It provides swift, efficient triage, with patients receiving a personalised care plan, including a diagnosis, condition information and a treatment plan within three working days, without having to leave their homes. This information is also communicated to the referring GP and included on the patient record. In contrast, traditional teledermatology is inefficient, requiring patients to attend longer, or additional, clinic appointments for assessment with a dermatoscope carried out by a GP or clinical photographer.
Method
After two years of development, significant investment and beta testing, MySkinDoctor launched in January 2019 with one CCG partner. A second joined in April 2019. It expanded to eight NHS contracts covering the South East, as a result of the COVID-19 pandemic. The resource provides swift and efficient dermatology services for patients, even under lockdown restrictions. Effectiveness and outcomes have been measured with designated KPIs, broadly categorised as: diagnosed and discharged; surgical outpatient appointment required; clinical outpatient appointment required, and referred to secondary care.
Results
Around 33% of all patients were safely diagnosed and discharged using MySkinDoctor, with a further circa 21% of patients being directly booked into a surgical appointment with an appropriate clinician. Patients and clinicians felt patients were more prepared for their surgical appointment when information regarding their treatment options, including videos, was provided in advance through the app, via their secure MySkinDoctor treatment plan. This reduced patient anxiety and clinic time. The remaining circa 46% of patients were booked for clinic appointments (c.43%) or referred on to secondary care (c.3%).
Measurable benefits brought by MySkinDoctor across the wider contract base throughout the COVID-19 pandemic period were: a circa 54% reduction in consultations required in clinic, with patients receiving diagnosis and a treatment plan or booked straight into surgery without needing to see a clinician in person; significant cost and time savings for patients using MySkinDoctor through eliminating the need to take time off work to visit a clinic and associated travel/parking costs; reduced pressure on GPs’ time, compared to traditional teledermatology models, as GPs had no increased workload or training in camera use and no additional hardware. In addition, MySkinDoctor incorporated direct triage into existing clinical pathways, with a three-working-day turnaround. Further benefits included: a 100% attendance at clinic following a MySkinDoctor consultation, versus normal 8% DNA rates; a <5% image rejection rate using MySkinDoctor that was quickly rectifiable by the patient within minutes, versus a 5% dermatoscope image rejection rate requiring patient re-booking for image capture and additional costs of photographer/GP time; a 100% Clinical Governance record; positive patient and GP testimonials. About 33% of patients were diagnosed and discharged back to their GP with treatment plans, eliminating the requirement for these patients to be referred to a physical clinic appointment.
Sustainability and Spread
MySkinDoctor is supported by Sussex Community Dermatology Service with considerable resources, including financial, premises, hardware, software, services and staff. There are 30+ administrative staff supported by 15 IT staff, allowing the app to be used by over 50 consultant dermatologists and GPs with Special Interests. Patient access to the app is incorporated into eight NHS contracts across Surrey, Sussex and Kent, with thousands of patients using it per month. The initiative has been so successful that all eight CCGs have extended their contracts. Patient, GP referrer and CCG feedback has been unanimously positive and there is a mandate to continue to develop the service indefinitely. The app is being promoted via the British Association of Dermatologists, with integration into the NHS app, and engagement with NHS England/Ireland and Kent Surrey Sussex Academic Health Science Network (AHSN). MySkinDoctor has been added to the NHSX digital playbook and is being rolled out to other parts of the UK. The NHS Outpatient transformation team has asked for advice to develop teledermatology services throughout the UK. Discussions are underway (under NDA) to roll out the app with primary care digital health platforms in the UK. It can now be offered to every CCG nationwide, and NHS counterparts have been approached with the offer of a National Dermatology Triage service. The app is easy to use, compatible with both iOS and Android, free to download from www.myskindoctor.co.uk and has about a 70% take up by patients who are offered it. Patient feedback is sought after every app use to ensure high standards. Monthly teledermatology case discussions are held by the dermatologists to provide a forum for continuing reflection and learning.
