Summary

This Tier-3 community dermatology service has been dedicated to serving the dermatological needs of the East Kent community since 2012. Over the years, the service has flourished, evolving into a multidisciplinary team committed to delivering accessible and high-quality dermatology and surgical care to patients across East Kent. In 2012 the service offered one consultant from one location; the team now sees over 12,000 patients a year, from six locations, with a team of 22 clinicians. The team’s ethos revolves around accessibility, quality and compassion, ensuring that all patients receive the attention and care they deserve.

Method

The community dermatology service has grown into a dynamic team comprising consultants, specialty doctors, GPs with extended roles (GPwER), nurses and support staff all working collaboratively to provide comprehensive care to patients. Patient care is streamlined with the aim to see the right person, in the right place at the right time. This is achieved by all referrals being triaged by an experienced GPwER, with both medical and surgical expertise. The nursing team plays a pivotal support role, covering isotretinoin reviews, cryotherapy and minor surgical procedures. Three consultant colleagues provide education and support with the most complex patients. This triage and pathway process ensures short waiting times. The nursing team runs clinics alongside doctors, so queries can be answered immediately and patient care is not delayed. The service is fully electronic, including secure clinical images embedded in electronic patient records. Clinicians also have full access to GP records.

Results

Success hinges on a collaborative spirit. Fostering open communication between dermatologists, nurses and support staff has achieved: shorter waiting times, through centralised triage, performed by the service leads working in both medical and surgical dermatology, streamlining the patient journey; earlier diagnoses, with shared knowledge, joint clinics and same-day biopsies enabling identification and diagnosis of skin conditions more quickly; service resilience, as a result of training all GPwERs and nurses in-house using a tailored training programme and service development; local education, with all staff living and working locally, their dermatology experience translates into their other community working environments, benefitting the whole local health economy. This collaborative approach translates to better patient outcomes and a more rewarding experience for everyone. Teamwork is the cornerstone of exceptional dermatological care. Over the last 12 years the service has thrived. In 2012 there was one site with one consultant. This has expanded to six sites, spread over a large geographical area, bringing care closer to patients’ homes via a team of 22 clinicians. Streamlined workflows and shared patient information systems have boosted efficiency. Nurse-led protocols have freed dermatologists’ time for complex cases. The nursing team sees 17% of all dermatology appointments. A PIFU system has been introduced, overseen by the team leads. Patients contacting the PIFU number are often called back by a clinician the same day. Patients requiring review are booked in to the most appropriate follow-up clinic. PIFU allows patients to take charge of their own healthcare, contacting the team when needed, reducing unnecessary appointments and clinic waiting times.

Sustainability and Spread

Referrals are reviewed on an ongoing basis and the aim is to take care closer to patients to provide an equitable service to patients across East Kent. The service has expanded from a service run by one consultant to a clinical team of 22. Most of the clinical team members were trained within the service. All clinical staff undertake a collaborative annual appraisal. A nurturing, supportive environment, responding to individual needs, is reflected in the team, which translates into better care for patients. The in-house education programme runs quarterly, delivered by the dermatology leads and external speakers. This provides a high quality and effective shared learning environment for all clinical staff. Undergraduate medical education is supported at Kent & Medway Medical School, as well as delivery of teaching to primary care allied health professionals, plus the East Kent Skin Club, which is open to all primary and secondary care colleagues.