Transformation of the routine management of dermatology cases

Gloucestershire has a population of approximately 650,000 spread across a large geographical area. There are 76 GP practices in the county which are split into 16 clusters across 7 localities. The majority of dermatology secondary care activity is provided by Gloucestershire Hospitals NHS Trust.

Existing service provision:

• Successful advice and guidance (A&G) teledermatology service with, on average, 250 requests a month. 90% of requests are responded to within two working days and 75% converted to primary care management
• Two-week wait conversion rate of 10% for suspected skin cancer referrals. Recent introduction (November 2017) of ‘One Stop Skin Cancer Service’ in secondary care has improved performance
  

Situation

• Incidence and prevalence of skin disorders has been increasing year on year
• Local referrals are rising as well as increased referrals from out-of-county, with demand and capacity issues within existing secondary care services
• Variability in quality of care depending on access to GP with an interest in dermatology
• Disparity in availability of minor surgery skills across primary care
• Patients travelling long distances to dermatology secondary care appointments
  

Aspiration

• Deliver improvements in primary care skills training in diagnostic certainty and management of common skin conditions
• Improve skin cancer detection rates in primary care with increased two-week wait conversion rates
• Speed diagnosis and management, saving patient journeys through increased use of digital technology in the care pathway, without compromising quality and safety
• Facilitate clinician-to-clinician communication and strengthen feedback and education of GPs
• Increase accessibility to minor surgery services in the community and avoid unnecessary surgical excisions
• Empower GPs to manage their patients with confidence and reduce secondary care activity
  

Solution and impact

Step 1: Develop a solid foundation of GP equipment, aptitude and attitude across the county:

• Enable each GP practice to have access to a dermatoscope
• Provide a one day training course in dermoscopy and digital imaging to all GPs and half day course to all appropriate practice staff across all localities
• Encourage the addition of more skin lesion photographs to the patient record
• Encourage increased use of advice and guidance for lesions of low or uncertain suspicion of malignancy
• Structured pathways to be published on local website (G-care) which GPs can use to support the management of skin conditions in primary care
• Develop and promote structured referral forms with minimum clinical information requirements and guidance for attaching images. This will enable enhanced vetting of referrals so that patients are seen in the most appropriate setting and clinical resources are used most effectively

Step 2: Develop local dermatology minor surgery training and accreditation:

• Develop cluster-based inter-practice minor surgery service, to ensure equitable access for patients to primary care minor surgery services across the county

Functionality and capabilities

There are several manufacturers and suppliers of dermatoscopes which are available for purchase from NHS Supply Chain. You can learn more from the links below. 

Find out more

Read more about the dermatoscope procurement guidance on the British Association of Dermatologists website.

Download more information about the manufacturers and suppliers of dermatoscopes (MS Word, 627kb). These are available for purchase from NHS Supply Chain.

Find out more about the digital dermoscopy training tools on the Royal College of General Practitioners website, including tips on taking dermoscopic and general dermatology images.

Find out more about the dermoscopy training from the Primary Care Dermatology Society.

Key contact

Dr Chin Whybrew, GP chin.whybrew@nhs.net

Dr Alan Gwynn, GP a.gwynn@nhs.net