NHS England - Transformation Directorate

Using an app for advice and guidance and referral management to help reduce dermatology appointments

The One Gloucestershire Integrated Care System (ICS) includes Gloucestershire Hospitals NHS Foundation Trust, Gloucester Health and Care NHS Foundation Trust, NHS Gloucestershire Clinical Commissioning Group (CCG), the South Western Ambulance Service NHS Foundation Trust and all of the region’s 73 GP practices.


The CCG procured digital cameras for all GP practices in the region in order to improve the triage of dermatology referrals, as 90% of 2-week wait referrals were sent through the NHS e-Referral Service (e-RS) without any images attached. The issue was one of accessibility: cameras were often left in the consulting room where they had been used and weren’t easily available for a GP consulting in another room when they needed it.


GPs, nurses and mental health workers wanted to access specialist advice and guidance quickly and securely by taking photographs using their own smartphone. Dermatologists in the Trust wanted an advice and guidance platform that enabled them to work remotely and triage patient referrals to the right pathway faster.

Solution and impact

The CCG commissioned Cinapsis SmartReferrals, a fully-integrated advice and guidance platform that gives GPs, nurses and mental health workers immediate access to specialist advice and guidance through their smartphone and web browser.

Photos are captured and shared securely using the Cinapsis smartphone app and are automatically saved into the patient’s record in EMIS Web and SystmOne. Advice and guidance requests are completed quickly with everything being recorded into the patient’s notes automatically.

Dermatologists in the Trust complete advice and guidance requests remotely using any device and do not require a smartcard – cases are completed much faster and more conveniently than before, taking 25% less time on average. This has significantly reduced response times, with GPs and nurses receiving an answer within minutes or hours rather than days.

The use of Cinapsis has improved patient pathways: all 2-week wait referrals are now undergoing image triage prior to an appointment. Integration with the patient’s medical record allows skin conditions to be easily monitored over time by the dermatologist or GP.

Cinapsis enables 70% of dermatology advice and guidance requests to be completed without the patient needing either a face-to-face or virtual dermatology appointment. Patients are triaged to the right outpatient clinic first time, removing unnecessary follow-ups and freeing up capacity in 2-week wait clinics.


  • Takes images securely on a smartphone using the Cinapsis app
  • Compatible with all modern smartphones and dermatoscopes
  • Fully integrated with EMIS and SystmOne – photos automatically upload into the patient record, e-RS, NHSmail and the NHS Spine
  • Allows patients to send images securely by sending them an SMS text message
  • Virtual consultations – clinicians can invite patients to a video or phone consultation from within EMIS or SystmOne.
  • Accessible through Apple and Android smartphone apps, through all modern web browsers and through EMIS and SystmOne
  • Attaches photos to NHS e-RS cases and advice and guidance requests
  • Sends photos by NHSmail from a smartphone or desktop
  • Patient consent built in automatically, including for teaching purposes
  • Customisable referral forms
  • Images can be annotated and cropped before uploading
  • Videos can be shared as well as still images


  • Takes and shares images securely using a smartphone and the Cinapsis app
  • GDPR and Data Protection Act 2018 compliant
  • Patients can send images directly into their record in EMIS or SystmOne by being sent a text or email
  • No data stored on personal devices or personal cloud
  • All data stored encrypted on the Health and Social Care Network
  • SNOMED CT coding of advice and guidance requests and responses
  • Shares images securely between clinicians: primary to secondary care, within secondary care and between clinicians in primary care
  • Allows configuration of local pathways and referral forms within the Cinapsis app
  • Allows access to advice and guidance through the Cinapsis app from local consultants or from consultants out-of-area through the Integrated Clinical Advice Network. Out-of-area consultants can support the delivery of advice and guidance by local services
  • Secure consultations for advice and guidance, including telephone call (direct and call back), video call and secure messaging
  • The integration with NHS Spine matches the patient’s NHS number to the NHS database
  • Comprehensive patient consent
  • Outcome is always recorded for the patient record


Cinapsis is a fully-integrated advice and guidance platform used by clinicians to take and share images and videos securely with colleagues. It is also used to collect images and videos securely from patients and to deliver virtual consultations by video or phone.

Key figures/quotes 

"Cinapsis is a pleasure to use: it's all in one and laid out really simply. I find it much quicker and simpler than the process of Advice and Guidance we were using previously."
Dr Tom Millard, consultant dermatologist at Gloucestershire Royal Hospital

“Saw patient with suspicious skin lesion. Sent summary and three photos via app to dermatology team. Diagnosis and management back within one hour. Impressed.”
Dr Mark Porter, GP and anchor for BBC Radio 4’s Inside Health

"Cinapsis is very intuitive and easy to use!”
Dr Chin Whybrew, GP at Stoke Road Surgery

Find out more

Clinicians and patients talk about their experiences using Cinapsis in this video

Download the case study on the British Association of Dermatologists website (pg 18)

Key contact

Dr Tom Millard, consultant dermatologist at Gloucestershire Hospitals NHSFT


Dr Owain Rhys Hughes, CEO of Cinapsis