Summary
Between 2018 and 2020 three consultant dermatologists in the department left the Frimley Health Foundation Trust. The dermatology service immediately came under threat with the cessation of speciality clinics and severely reduced capacity. Key aims were stabilising the department and then focusing on rebuilding services using available resources. Facing this challenge required a huge commitment from the dermatology team. Remaining motivated and using intelligent solutions to continue to provide high quality services were high on the agenda. A concerted team effort not only achieved initial goals but surpassed expectations, making this a leading service in the Trust.
Method
The remaining consultant took on clinical lead, the ICS Dermatology Steering group and training of existing staff. Dermatology specialist nurses started training to enable extended roles. Role changes were made from dermatology to skin cancer specialist nurse to improve skin cancer care. A consultant-led, super clinic model was initiated to meet service demand. This required flexibility and coordination from the team. Closer relationships were developed with administrative support staff to streamline workload. A redistributed clinical team retained existing specialist services rather than redirecting patients out of area. New clinics and proformas were designed to distribute clinical workload more effectively. A commitment was made to recruit locally. A designated mental health first aider monitored and supported team well-being. Joint clinics with plastics forged a close relationship to provide most surgical management for skin cancer patients efficiently
Results
The new approach saw a consistently higher number of patients than the national speciality average, which increased year on year (50% over the national average in 2022). Feedback analysis for 2022 demonstrated high patient satisfaction with the service provided. The capacity of systemics monitoring doubled and clinics for acne, skin cancer and biopsy were created through developing extended nurse roles. Two nurse prescribers were employed within two years. Service efficiency benefitted from nurse-led management. Over 97% of inpatient referrals were remotely handled, compared to previously, when all had been in-person and at a different site. This reduced delays in advice and clinician burden, as well as utilising clinical time more effectively. A ‘Derma Drive-Thru’ initiative in primary care generated less than 10% two-week wait (2ww) referrals, as a direct result of GPSI training in the 2ww clinics.
Sustainability and Spread
The dermatology team’s efforts have been recognised at Trust level and cross-site initiatives have disseminated successes to motivate other teams. Outcomes are discussed at clinical governance meetings. The initiatives have been presented internationally (‘Setting up psychodermatology services’ ESDAP 2022). Good distribution of clinical workloads across the team reflects experience and competency. Senior specialist nurses are training junior staff in extended roles, removing part of that responsibility from the consultant workload. Clinical governance responsibilities have been allocated across the team. There is a commitment to train all staff to see patients in all clinics, to enable mobilisation where needed and build clinical experience. Nurses are encouraged to take sabbaticals between skin cancer an inflammatory work to increase knowledge and develop transferable skills.
