Transforming dermatology services in the east of England

What is the aim?

Demand for dermatology services across Norfolk and Waveney has grown due to an ageing population that is more susceptible to serious skin conditions, while the resulting increase in waiting lists has been further exacerbated by the COVID-19 pandemic.

Transforming dermatology care via a new digitally-led, rapid referral process which uses the camera function on a smartphone to allow GPs to collect and share diagnostic images.

The technology creates a faster and more continuous dialogue between care practitioners and hospital-based consultants, speeding up diagnosis and enabling more cases to be treated in the community rather than in hospital settings, thereby dramatically reducing expected waiting times.

It also encourages knowledge sharing between GPs and specialists, helping to improve professional standards and as part of a wider regional improvement programme enabled by technology the project is helping to inspire similar innovation across other areas of care.

The project aims to:

  • reduce average waiting times for hospital-based consultant advice to 48 hours for routine referrals
  • support better outcomes by ensuring patients receive treatment sooner, including identifying serious diseases that should be referred through urgent pathways
  • boost patient experience by allowing more care to be offered closer to home, with around 60% of all treatment expected to be conducted in primary care settings in the future
  • improve clinical practices by creating strong, equitable relationships between primary care and consultant teams through enhanced contact

What is the solution?

The technology turns the smartphone into a powerful clinical tool that allows GPs and other primary care practitioners to capture skin observations and images which can be shared quickly with specialists for further investigation and diagnosis.

This is achieved by attaching a specialised magnifying lens called a dermatoscope to the phone to take high-definition images of the patient’s skin. Dermatoscopes are used by dermatologists to examine skin lesions. The lens can be magnified up to 10 times to capture clear, clinical-grade photographs.

An app on the smartphone then allows the user to connect to a secure digital referral management platform, provided by Cinapsis, which allows the patient information and imagery to be shared with both primary and secondary care practitioners. Office-based systems also connect to the platform.

System interoperability and security are integral to the project’s long-term success. Extensive review and testing have been completed by the project team to test the referral platform is capable of securely speaking to a wide range of IT systems.

What is the impact?

Early evaluation shows that 492 patients have already benefited from the digital service across the area.

  • 89 GP practices were live with the technology at the end of June 2021.
  • As well as improving patient experience, there is also expected to be non-cash releasing savings of £1.4 million a year by reducing demand on acute services.
  • Nearly three-quarters (74%) of these cases were managed in primary care and all were reviewed by consultants within 48 hours compared with an approximate 50 weeks routine wait.

How is the technology working in practice?

We asked a selection of health professionals working with the dermatology service to describe the real-world impact of the technology on their patients and their own working practices. Here are their personal experiences.

Putting patients at the heart of care by reducing waiting times and bringing support closer to home

Amy Crawford, Transformation Lead for North Norfolk Primary Care, highlights how the technology helps to put patients at the heart of care by reducing waiting times and bringing support closer to home.

Digital technology is radically reducing the amount of time GPs have to wait for expert advice

Dr Katie Pryce describes how the technology radically reduces the amount of time it takes for GPs to receive expert advice from specialists which provides greater reassurance and support for the GP and enables the patient to start treatment faster.

Digital technology is opening new possibilities for how care might be delivered in future

Dr Mark Lim, Interim Director of Clinical Services and Clinical Transformation at NHS Norfolk and Waveney Clinical Commissioning Group, describes how the technology enhances the relationship between clinical teams, opening up new possibilities for how care might be delivered in future.

Key lessons and next steps

Looking ahead, how might this project help to shape the future direction of health services in the region? We asked members of the project team to outline the key lessons that are shaping their priorities for the future.

Delivering system-wide benefits

As well as showcasing the potential of technology, this project is a good example of taking a fully integrated approach to care. It has created new methods of communication between primary and secondary care and has yielded benefits that can be shared across the system.

While helping to meet the immediate challenge of reducing waiting times for dermatology services, this approach is also proving to be an invaluable way of training and supporting GPs so that they have the knowledge to refer patients with greater confidence in the future.

Creating advocates for change

Identifying GPs who share the same vision has played an important role in getting this project off the ground. Having these advocates has been vital for building credibility and raising awareness among health professionals.

Engagement approach included live and recorded videos that could be watched at any time, and was designed to give GPs and practice managers a flexible way to get involved. These sessions have been crucial to the success of the project and have enabled continued dialogue with health professionals.

Extending beyond dermatology services

Knowing the tool is safe, secure and has the interoperability necessary to work with other systems as a result of the extensive planning and user testing.

There is now a golden opportunity to apply the same principles and technologies used to transform dermatology services to enhance and improve other areas of care, both here and elsewhere.

Find out more

You can read the full case study on the work across the region on our Innovation Collaborative workspace at FutureNHS.

Join the National Innovation Collaborative

The Innovation Collaborative is open to all NHS, social care and local authority staff with an interest in remote monitoring, providing access to peer-to-peer support, guidance and tools designed to help you implement a remote monitoring service.

Existing members can access the Innovation Collaborative Digital Health workspace on the FutureNHS platform. Alternatively, to join or ask any questions email innovation.collaborative-manager@future.nhs.uk.