Summary
The Royal Berkshire Hospital (RBH) dermatology team employs compassion and expertise to put patients at the forefront of their care. This dynamic and driven team of healthcare professionals goes beyond treatment, focusing on collaborative working with primary care, research, rheumatology, education, pharmacy and wellness for both patients and staff. Successful innovations include GP outreach, regular primary face-to-face education, nurse-led and specialist pharmacist clinics with new initiatives to reduce tertiary referrals, as well as away days and teambuilding days.
Method
The RBH team tackled the national shortage of consultants by recruiting and training other allied healthcare professionals to provide an excellent service for patients. The team included a specialist dermatology pharmacist who worked collaboratively with nurse consultants. Collaboration ensured new advanced therapies were available and there was early treatment access, which changed patients’ lives. Inflammatory clinics worked autonomously, ensuring medical consultants were free to concentrate on skin cancer and more complex cases. A successful initiative was a collaboration with Rheumatology to undertake joint clinics (both nurse- and doctor-led). A unique GP outreach programme delivered three, hour-long, consultant-led educational sessions to every primary care network in Berkshire, backed by pharmaceutical sponsorship. Flexible clinics were introduced to accommodate seasonal changes.
Results
Education is ongoing, with primary care dermatology topics chosen from common themes in advice and guidance requests. Excellent verbal and written feedback has been received, with requests to continue the programme and provide sessions with a view to nurse consultants (NC) providing teaching. Regarding in-house education, there is pharmaceutical teaching every week, a NC educates the nursing team once a month, plus there is a whole department academic meeting. The NCs meet with the director of nursing every six weeks to facilitate wellbeing and education opportunities. Recruitment challenges have been addressed by recruiting more GPs with extended roles (GPwER), who then educate their primary care colleagues. Through using a specialist pharmacist, the number of advanced therapy patients has increased; they are seen in person every six months. There is increased access to new, advanced therapies. Autonomous working and closer relations with pharmacy homecare have improved patient care. NCs are teaching homecare nurses about dermatology conditions, cementing closer links. A further NC, consultant and clinical fellow have been recruited. A skin cancer multidisciplinary team away day promoted staff wellbeing and education. Commercial and academic research has been started, with a view to attaining university status.
Efficiency has improved because of GP outreach; the rate of referrals has plateaued. GPs are being educated in dermatology and gaining an interest. RBH consultants keep up to date to deliver education. Patients are referred correctly and treated correctly in primary care. Tertiary referrals for initiating first-line biologics in Hidradenitis suppurativa (HS) and adolescents have been reduced, reducing patients’ waiting time to begin medication by six months. Patients have been discussed at the Oxford/RBH multidisciplinary meeting and the process for shared care has started. Reduced Rheumatology referral waiting times have been reduced as patients can be referred to the nurse-led rheumatology/dermatology clinic for assessment and potential treatment. Use of the staff wellness centre is encouraged.
Sustainability and Spread
The aim of the GP outreach programme is to equip primary care clinicians with the skills to diagnose and treat more dermatological conditions without the need for specialist input. It aims to continue long term to ensure ongoing professional development and is backed by the CCG. A NC has spoken on initiatives used within the RBH at medical society meetings, with other hospitals developing some of the ideas. A monthly biologic newsletter is shared. Relationships have been strengthened between the rheumatology and dermatology department and pharmacy, which has eased access to new medications. The NC teaches nurses throughout the hospital about being involved in research and how to become a Principal Investigator. Education has been strengthened through new nurse development pathways within the trust to ensure equal opportunities. The team has regular weekly slots for pharmaceutical teaching and evening sessions to allow sharing of best practice.
Dermatology Team of the Year
Royal Berkshire Dermatology Team
