Teledermatology advice and guidance service at the Barts Health NHS Trust

The dermatology department at Royal London Hospital has been providing advice and guidance (A&G) to local GPs since July 2019 to adapt to increasing demand. Tower Hamlets did not have a dermatology community clinic.


The dermatology department has received an increasing number of outpatient referrals over the last 10 years but couldn’t easily increase its capacity. Patients were experiencing long waiting times to be seen by a consultant in the hospital outpatient clinic.

The COVID-19 pandemic also resulted in further challenges because lockdown limited the availability of face-to-face consultations in primary and secondary care. This created a need to find an effective and safe system to triage referrals and prioritise patients with a clinical need to attend hospital appointments.


Use of e-Referral Service (eRS) advice and guidance to enable effective referral triaging  using digitally-shared photos and clinical information.

Solution and impact

The department is able to provide advice for management in primary care for more than 50% of A&G requests, or prioritise those that need hospital appointments, depending on clinical need and urgency.


The provider is able to respond to GPs with advice or instructions for a referral to secondary care.


e-RS is not linked to hospital records (Cerner) and does not allow directly-booked appointments.


Consultants are able to respond remotely from a clinical setting, or from home, reducing the risk of losing capacity during the COVID-19 pandemic due to lockdowns or self-isolation needs.

Key figures/quotes 

As of November 2020, dermatology is currently the largest recipient of A&G requests at Barts from Tower Hamlets GPs - 28% of the 3,961 A&G requests to Barts Health were for dermatology advice.

Activity from April to October 2020 is detailed here:

  • April 2020 - 30 A&G requests
  • May 2020 - 176 A&G requests
  • June 2020 - 285 A&G requests
  • July 2020 - 363 A&G requests
  • August 2020 - 263 A&G requests
  • September 2020 - 314 A&G requests
  • October 2020 - 253 A&G requests
  • Total - 1684 A&G requests

The Trust is working closely with GP colleagues in the CCG and the GP lead for dermatology. In addition to the educational component of the A&G response, quarterly teaching sessions for local GPs are also running.

Find out more

Read more advice and guidance on the Tower Hamlets CCG website

Elective Care community of practice

The FutureNHS platform hosts tools and resources to support local health systems implement Advice and Guidance services. To request access to this, please email

Additional resource

Elective Care Transformation Programme  

Advice and guidance toolkit for the NHS e-Referral Service

Key contact

Dr Rebeca Goiriz, consultant dermatologist at Barts Health NHS Trust