Summary
High volume skin cancer services continued, despite redeployment, staff sickness, and increased referrals. The team developed a virtual 2WW skin cancer service and image uploading portal, allowing referrals to be received via ERS, for swift triage and prioritisation. Based on the teledermatology service review, guidance hubs were introduced, with one consultant supervising four trainees, improving training opportunities and response time. GPs were educated to improve referral quality, support communication with secondary care and enhance patient care. Waiting lists were validated and the backlog was cleared by hosting evening and weekend clinics, plus a new, high volume clinic in the local shopping centre, drawing national attention.
Method
The team worked together on a plan to use digitalisation to triage referrals. This was a large-scale change for the service but, with everyone backing the scheme and open to adapting, patient wait times were improved and the right patients were seen at the right time in the right place over the pandemic period. The team worked closely with the trust IT, administration and clinical teams to ensure the system worked and everyone was confident in its efficacy. New advice and guidance hubs were launched, enabling strategic use of limited consultant time for greater supervision. One consultant was able to supervise four trainees. This led to more patients being safely reviewed, more swiftly, while working with limited clinical space because of COVID-19 restrictions.
Results
Teamwork and drive to bring the electronic system to life improved the care given to patients by ensuring that they were triaged and seen swiftly, again ensuring that the right patients were seen at the right time in the right place. The consultant supervision meant that more trainees could learn and gain experience during the pandemic, at a time when their education might have been severely impacted. The team took part in University Hospitals Dorset 's Outpatients Assessment Clinic high flow clinics in the local shopping centre. This was a great opportunity to allow more patients to be seen in a patient-focused environment that was easier for the community to access. This was a change to working practices, but ultimately helped to provide the best possible care to patients. Just one digital advice and guidance session reviewed 115 patients in three hours. This was the work of one consultant and three trainees. Usually this would be a much longer patient clinic list if they were seen face to face. The efficiency of these clinics meant that some patients did not need to be seen in secondary care, freeing more appointment slots for those who did. Engaging with GPs in education evenings about teledermatology, and increasing their understanding of its benefits to the integrated care system, improved the quality of their referrals. This made the system more efficient, so the right patients could receive dedicated secondary care.
Sustainability and Spread
Teledermatology audits showed increasing numbers of referrals, but triage and review enabled patients to be seen more efficiently, and urgent patient referrals could be expedited. This approach was adopted by the whole team. The clinical templates were changed to accommodate urgent referrals being seen more efficiently. More training opportunities are needed to create more consultants, which is something the team can implement now it has a proven, working system.
