Summary

DMC Healthcare, an independent NHS service provider, Lincolnshire Integrated Care Board (ICB) and United Lincolnshire Hospitals NHS Trust (ULHT) collaborated to address the dermatology waiting lists in Lincolnshire following the COVID-19 crisis, which surged to nearly 8,000 patients with wait times exceeding 100 weeks. DMC Healthcare supported almost 3,000 patients confirmed for treatments referred from the Lincolnshire Elective Activity Coordination Hub (EACH), operated by Lincolnshire ICB and ULHT. EACH served as a centralised service for referrals to review and validate the entire waiting list. This ongoing collaboration underscored a commitment to continuous improvement with plans to extend its impact across specialties, setting a precedent for effective healthcare delivery.

Method

This initiative sought to tackle the backlog of dermatology patients in Lincolnshire following the COVID-19 pandemic. The pandemic caused a significant increase in patients awaiting treatment, resulting in prolonged waiting times. Compounded by Lincolnshire’s coastal location and substantial population, challenges in accessing dermatology services were amplified by transportation limitations and socioeconomic gaps. In response, DMC Healthcare, Lincolnshire ICB and ULHT worked together to introduce a seamless patient pathway tailored to address regional challenges, beginning in April 2022. The EACH team conducted proactive reviews of waiting lists, reaching out to all patients who had been waiting over 52 weeks to confirm if an appointment was still required and ensuring accessibility to Grantham Hospital. DMC Healthcare then delivered streamlined pathways and effective management of validated referrals, providing both diagnosis and treatment. This included a consultant-led community dermatology service with multidisciplinary support provided by consultant dermatologists, surgeons, associate specialists and local GPs with extended roles, overseen by a consultant dermatologist for clinical guidance.

Results

This collaboration significantly reduced elective dermatology waiting lists and waiting times, enhancing patient access to treatment and improving the overall treatment experience. EACH validated approximately 8,000 dermatology patients, with over 1,600 patients (20%) discharged as they no longer required treatment and 3,000 (37% of the total waiting list) referred to DMC Healthcare for diagnosis and treatment. Additionally, operating solely on two weekends per month, DMC Healthcare successfully saw 82 patients during the initial weekends. As of November 2022, the waiting list for routine dermatology patients with a wait exceeding 78 weeks surpassed 1,800 individuals. Over the 22-week period since the initiation of this project, there was a reduction of 1,088 patients, amounting to 58%, equating to an average weekly reduction of 49 individuals.

Sustainability and Spread

The initiative, which has successfully provided high-quality dermatological care to patients in Lincolnshire, serves as an exemplary model for addressing waiting lists in other specialised areas. DMC Healthcare plans to expand it to other specialised services and share it as a case study with more NHS partner organisations, ensuring widespread benefits. Stakeholders have actively promoted the project’s success, with DMC Healthcare meticulously documenting its achievements and producing a comprehensive case study for online dissemination. Additionally, Dr Julia Schofield MBE, consultant dermatologist at United Lincolnshire Hospitals NHS Trust and associate professor at the University of Hertfordshire, as well as dermatology clinical lead for the NHS England Outpatient Recovery and Transformation Programme, has presented summary information about the service and its results at several webinars, reflecting the learning from the initiative’s development and implementation. This collective effort aims to share knowledge and best practices on a broader scale.