Summary
The project is transforming dermatology care through a digitally led, rapid referral process, which enables dialogue between GPs and secondary care specialists and results in treatment plans being agreed in hours rather than weeks. Bridging gaps in clinical communication, it has proven effective in reducing pressure on NHS services, while enabling strong dialogue between the clinical teams, promoting knowledge sharing and education. With backlogs and record service demand placing high pressure on the region’s primary and secondary care services, the suite of teledermatology technology ensures patients receive the right care, first time around.
Method
Two principal and longstanding issues meant teledermatology offered a solution to systematic diagnostic challenges in Cheshire and Merseyside Integrated Care Partnership (C&M ICP). First, poor integration of information technology made it difficult for primary care practitioners to take, transfer and store digital images. In addition, images received by secondary care were often of insufficient quality. Second, a high number of inappropriate and benign moles and skin lesions were referred through the two-week wait (2ww) cancer pathway, burdening Trust dermatology departments. Prior to project rollout, 30% of dermatology 2ww referrals were unnecessary, costing over £1 million annually. After two years of planning and trials, Cinapsis and Heine were selected as the most impactful and user-friendly teledermatology solutions. The technology aimed to address diagnostic challenges by allowing primary care practitioners to capture high quality digital images and send them for remote, specialist review, reducing the burden on departments and improving patient outcomes. Starting in July 2020, a working group of six GP practices from the SWAGGA Primary Care Network oversaw the project’s development and progress on a weekly basis. As the project expanded, the working group became the delivery arm for Liverpool CCG and its 85 GP practice members. A patient representative joined the steering group to advise on service model development. All Liverpool and locum GPs were invited to the Skin Club regularly, to learn about the project and see the Cinapsis platform and Heine dermatoscopes. Over 150 delegates attended.
Results
GPs benefit from access to timely advice from experienced secondary care clinicians, which enables more patients to be managed out of hospital, where that is safe and appropriate, and reduces pressure on NHS hospitals, while helping to prevent staff burnout. The project has improved experience and outcomes by: reducing the pressure on secondary care teams so they can focus on critical and specialist services, through managing over 49% of patients in the trial in primary care who would have been referred to secondary care previously; achieving an average of 26 hours and 30 minutes turnaround time for specialist management plans in the first year, as well as reducing the number of benign moles and skin lesions being referred into secondary care via the two-week wait (2ww) cancer pathway. This was not only a drain on resources, but also caused needless worry for thousands of patients.
Sustainability and Spread
A written case study was submitted to NHSX in 2022 as part of the funding requirement and published on its website. The project was also part of a national evaluation through the Cancer Alliances. On a local level, the project reports to the Cheshire & Merseyside Elective Care Recovery and Transformation Programme Board, which has become part of the ICB through reporting into Cheshire & Merseyside Acute & Specialist Trusts. Reporting and representation through local structures has been successful in securing further funding for 2023-24 to continue and achieve full roll-out and service maturity, as well as to extend and begin piloting the model in other areas of Cheshire and Merseyside without teledermatology infrastructure. The one-year arrangement is also the platform to establish an ICB Service Specification to procure and contract a system-wide service model from 2024, sustaining the project within national planning guidance expectations.
