Summary
The London North West (LNW) Dermatology team (Northwick Park, Central Middlesex and Ealing Hospital) has worked hard and succeeded in improving substantive recruitment of consultants to stabilise the service. It strived to improve collaborative working with other specialities for its biologic patients. Pre-COVID-19, novel, pharmacist-led clinics were successfully implemented for acne, systemic and biologic patients. The team has embraced change by adding a two-week-wait (2WW) teledermatology service to help manage increased demand.
Method
Pharmacist-led clinics are an exemplar of good practice, according to the Getting It Right First Time (GIRFT) review. The pharmacist is a clinically advanced, independent prescriber who can carry out skin assessments (PASI/EASI) as well as lymphadenopathy checks. Senior nurse-led biopsy clinics, including excisions, help to manage increased surgery demand. The team is broadening its horizon by implementing teledermatology for other dermatology services, in addition to 2WW. The establishment of an internal biologic MDT is an innovative effort to ensure patients are prescribed the appropriate treatment and allows staff to maintain skill sets. Members of the team attend MDTs at regional level with peer trusts to share cases and discuss complex patients, allowing engagement at sector level. The joint rheumatology and dermatology clinic has increased patient satisfaction. The team is also embracing patient-initiated follow ups (PIFU).
Results
Through innovative clinical leadership, networking and job planning, a robust senior team is in place, with Certificate of Eligibility for Specialist Registration (CESR) candidates to facilitate specialist clinics, including hair and nail, patch testing, Mohs surgery and biologics. Pharmacist-led clinics have created capacity in consultant clinics. This has ensured that patients are seen routinely and there has been a reduction in patients lost to follow up.
Nurse-led surgery has resulted in reduced waiting time for 2WW surgeries, including excisions. The biologic clinic has allowed close monitoring of high-cost drug expenditure, as well as ensuring that patients are on appropriate treatment. The teledermatology service has the potential for GP education and reduction in unnecessary referrals. Substantive recruitment has been effective, with the department recognised as an employer of choice due to its strong reputation. This has ensured the right patient is seen by the right healthcare professional at the right time, in turn resulting in improved patient experience and satisfaction. Less patients are lost to follow up and the referral to treatment pathway has improved. Availability of specialist clinics has expanded the service portfolio and improved training for CESR candidates. The team performs above the national target for 2WW, which has been recognised by the trust. Ongoing challenges are recognised and the team continuously looks to improve pathways, such as PIFU. The surgery capacity and teledermatology services are being expanded.
Sustainability and Spread
The clinical lead for LNWH will be chairing CRG meetings, which will enable North West London sector-wide dissemination of practice. Pharmacist-led clinics are being implemented at other trusts. Outpatient transformation work is in progress with the North West London sector to share good practice, including PIFU. The better functioning advice and guidance service shared with primary care colleagues will be shared across North West London.
