Summary
The Isle of Wight (IoW) has one of the highest rates for skin cancer in the UK and an ageing population, plus overstretched primary care and geographical isolation. Specialist recruitment is an ongoing problem and a solution was needed to address long-term security of locally-provided skin cancer assessment services. The Lighthouse Clinic unit, together with Wessex Academic Health Science Network and Gnosco, a Swedish technology company, worked collaboratively on creating and evaluating a new service. High quality digital images, including dermoscopic ones, are taken in primary care through a mobile app and, using an online platform, assessed remotely for skin cancer.
Method
A workshop was held with all stakeholders and teledermatology was agreed to be necessary for service sustainability on the IoW. Then the dermatology unit was approached by Wessex AHSN and invited to collaborate on the new UK product, Dermicus. Software changes and NHS Digital approval were supported and enabled through the collaboration, with referral templates and online platform operability confirmed and shaped by the local Skin MDT and IoW Cancer Forum. Initial rollout of the service was to two volunteer Champion GP practices. After three months, expansion continued to the rest of the IoW, with all practices on board within six months, just as the COVID-19 pandemic hit. Macmillan awarded a grant of £5,000 to support training in primary care in the use of the kit. The Clinical Governance Framework, Clinical Risk Assessment and Data Protection Impact Assessment were completed and formally approved by relevant bodies. The mobile app and web platform were customised for NHS use and the technology company supported to ensure NHS Digital standards for data security, storage and compatibility were achieved. The referral template was developed and agreed to by the Skin Cancer Local MDT and Cancer pathways team, with sign off by the consultant dermatologists and some GPs, who tested the form for ease of use. Once approved, practices were invited to be Champion sites for three months prior to island-wide deployment. Wessex AHSN supported real-time evaluation of the service using data analysis, questionnaires and interviews.
Results
During the period of formal evaluation approximately 50% of the referrals were assessed as being lesions that did not require face-to-face input. Advice leaflets were sent to those patients. A further 25% were booked straight to biopsy. The direct impact for people with potential skin cancer was reduced waiting time to hear that their skin condition was benign, thus reducing stress, travelling time and time off work. Those who needed to be seen had fewer visits to the clinic, as they could be booked straight to biopsy. An information leaflet sent out to them about what to expect at the appointment and the procedure. Cases that were misidentified by the primary care referer to be lower-risk lesions were brought in more quickly for assessment or surgery than would have occurred using the standard referral system.
Sustainability and Spread
The model has been used on the NHS Framework for Digital Transformation as an example for cancer pathways, as well as becoming a Health Service Innovation award finalist. The service has featured in several articles published online and in print, as well as on BBC South. This publicity enables other departments and commissioners considering implantation of new models to understand the process. The team also presented the service model at the annual British Association of Dermatologists’ Teledermatology Training day in October 2019, which is aimed at commissioners, service leads and clinicians.
