Summary
In December 2022, a community dermoscopy service was introduced in East Suffolk for patients with skin lesions, delivered by experienced primary care clinicians and managed by Suffolk GP Federation. The service aims to improve the quality of secondary care referrals, reduce unnecessary hospital activity and provide care closer to home for patients. To date, 285 patients have attended, of whom 68% have been discharged with reassurance. A total of 31 patients have been referred on the two-week wait (2ww) pathway, supporting faster cancer diagnosis. There has been a 32% reduction in referrals to secondary care, with associated cost savings and excellent patient feedback.
Method
In the context of COVID-19 and an aging population, the demand for specialist dermatology services was increasing, with ongoing challenges locally in managing the volume of 2ww referrals. With limited consultant dermatologist resource, a new approach was needed.
The objectives of this service, to be achieved across two primary care networks (PCNs) by 31 March 2023, were: to improve the quality of referrals to secondary care (measured by all 2ww referrals having dermoscopy images attached and improved biopsy rate); to reduce unnecessary hospital activity and provide care closer to home (measured by reduction in dermatology referrals), as well as to gather patient feedback to inform future expansion of the service. A project group was established with key stakeholders, including clinical, operational and transformation leads from Suffolk GP Federation and Suffolk and North East Essex (SNEE) Integrated Care Board (ICB). A mobilisation plan was developed with key milestones, including pathway configuration, workforce, estates, equipment and communications. The outcomes were reported to the dermatology steering group with consultant dermatologist representation, as well as to the ICB executive team via the relevant committee. As a result of positive outcomes and patient feedback, the pilot was extended and funding is being explored to expand the service across East Suffolk.
Results
The community dermoscopy service achieved its initial objectives, namely: improved quality of referrals to secondary care (100% of 2ww referrals had dermoscopy images attached in line with national guidance); 31 2ww referrals were sent, supporting faster cancer diagnosis; improved biopsy rate (66% compared to 25% previously); reduced hospital activity and care closer to home (285 patients seen and 68% discharged with reassurance); a 32% reduction in dermatology referrals; 50 fewer outpatient appointments to date; positive patient feedback, plus reduced health inequalities through enhancing the local teledermatology pathway and mitigating against digital exclusion. In addition, the Outpatient Transformation Benefits Calculator showed the potential impact on patients and the environment if the service were expanded across east Suffolk: 129,032 patient travel miles saved; 4,316 hours of patient time saved, as well as reduced CO2 emissions (22.6 tonnes).
Sustainability and Spread
With expected cost savings, the intention is for the acute Trust to fund the service from April 2024. For 2023, a bid was submitted for funding to expand the service across East Suffolk. This would enable further data collection and a health economic evaluation to demonstrate the impact of this pathway redesign on the system. The SNEE Training Hub is currently funding a primary care dermatology professional development programme to support sustainability of the primary care workforce. This includes funding clinicians to complete a dermatology diploma with a view to supporting community clinics in future. The project outcomes have been shared with colleagues across the ICB in primary and secondary care and with Healthwatch Suffolk, which has been gathering patient feedback on dermatology care. The work is being showcased in the ICB annual report and will be disseminated via other communication channels, including newsletters and staff education days.
