Teledermatology Advice and Guidance (A&G) service at the Barts Health NHS Trust

Since 2011, the dermatology departments at Barts Health NHS Trust have received an increasing number of tertiary care referrals. This was while serving the local population and providing secondary care services.

Situation

There were more than 17,000 annual referrals before the COVID-19 pandemic.

Patients had long waiting times for routine referrals and the service had a limited ability to increase clinic capacity. The Trust needed an innovative solution to address these needs. 

Aspiration

The dermatology department joined the Trust Outpatient Redesign Working Group in January 2017. It proposed to implement Advice and Guidance (A&G) using the e-Referral Service (e-RS).

The Trust aimed to:

• reduce delays and barriers that patients may face for safe and effective care
• educate primary care clinicians and support them to manage skin conditions safely
• prioritise providing care in a timely manner to patients who need specialist care

The Trust proposed that 66% of the requests could be managed with advice. This would help to:

• reduce unnecessary attendances to secondary care by 30%
• give quick access to consultants’ advice within 5 working days
• improve triaging of referrals to secondary care

Solution and impact

Following a successful pilot, in July 2019 Tower Hamlets Clinical Commissioning Group commissioned the Trust to provide teledermatology using the e-RS A&G.

The service gradually expanded and now receives requests from the North East Thames region, with an estimated population of over 2 million.

300 to 400 A&G requests are received every month. Only 30% of requests result in a face-to-face appointment.

Functionality

A&G allows clinicians to upload photos and information onto e-RS for secondary care clinicians to:

• provide advice
• request further information
• convert the request to a routine, urgent or 2 week wait appointment in clinic

Capabilities

A&G helps referring clinicians to quickly get advice from consultant dermatologists on:

• investigations
• treatment plans
• triaging referrals
• diagnosis

The platform can also educate GPs and give personalised feedback and supervision for those who want to develop their dermatology clinical skills. 

Scope

• The service supports primary care clinicians to make informed, quick clinical decisions about appropriate care for their patient. 
• It gives primary care clinicians direct access to secondary care specialists to reduce inappropriate outpatient referrals. 
• The service helps to bridge expertise across care sectors and specialties. 
• The time to treatment is reduced and so improves patient outcomes.
• Dermatology registrars remotely manage dermatological conditions under consultant supervision. This provides opportunities for teaching and assessment, allowing personal development.
• The service offers opportunities to work remotely, allowing services to continue running during COVID-19 lockdowns and staff self-isolation.

Key figures

The dermatology department is one of the largest A&G providers at Barts Health and has expanded resources to continue responding within 5 working days.

The team received a record 432 A&G requests in March 2021. 356 were responded to within 2 working days and 108 were converted to appointments in the clinic.

39 local GPs responded to a recent survey. It showed high levels of satisfaction with the service. They said it:

• was effective at providing timely and useful responses
• reduces unnecessary referrals to secondary care
• provides learning opportunities

Find out more

Read more advice and guidance on the Tower Hamlets CCG website

Key contact

Dr Rebeca Goiriz, Consultant Dermatologist, Barts Health NHS Trust

rebeca.goiriz@nhs.net

Dr Zeeshaan Hasan, Locum Consultant Dermatologist and Topol Digital Fellow, Barts Health NHS Trust

zeeshaan-ul.hasan@nhs.net