NHSX’s Digital playbooks “have been developed to support clinical teams to reimagine and redesign care pathways by showcasing tried and tested technologies to solve real-world problems.” They highlight challenges faced by people working in different NHS organisations and share solutions and best practice.
Consultant Connect is the only provider to have THREE projects featured in the NHSX Dermatology Digital playbook. We have replicated these below. Click the title you’d like to read or scroll through to read them all…
A teledermatology pilot to improve cancer care in Leeds
Read the full case study on NHSX website or we have replicated it below:
Leeds Teaching Hospitals NHS Trust is one of the largest and busiest acute hospital trusts in the UK, offering a range of both general and specialist hospital services for people from the city of Leeds, Yorkshire and the Humber and beyond. The Trust treats around 1.5 million patients a year.
Situation
A national shortage of consultant dermatologists and an increase in the number of skin cancer referrals from GPs. Walayat Hussain, consultant dermatologist at Leeds Teaching Hospitals Trust, looked at the data about patients referred by GPs and subsequently discharged without any clinical intervention: this amounted to about one third of the referrals. This led to the thought that there should be a way of making a decision without the patient needing to visit hospital, with a possible solution offered by GPs sending images of suspicious lesions to the consultants.
Aspiration
The Leeds Cancer Programme to pilot a new pathway for suspected skin cancer cases to speed up diagnosis of skin lesions and reduce demand on the two-week wait pathway.
Solution and impact
A pilot study was carried out to test the hypothesis. GPs were provided with specialist magnifying devices which enabled them to take images of the lesions using a smartphone or tablet. They sent images to a consultant dermatologist (identified only by the NHS number) but also referred the patient through the normal pathway. Walayat compared his diagnosis based on the image with the outcome of the face-to-face consultation: in every case the diagnosis was the same. The evidence led to national cancer transformation funding provided via the West Yorkshire and Harrogate Cancer Alliance. A steering group with representatives of every organisation on the pathway was established to progress and oversee the project.
All GP practices in Leeds are now using the imaging system, which works via the Consultant Connect App with which they were already familiar. Supporting material and videos were used to explain the system to GPs and to patients. The imaging process that needs to be done by the GP takes just 30 seconds, so does not adversely affect GP appointment times. After getting patient consent, the GP takes three images to send to the hospital.
The teledermatology scheme in Leeds enables GPs to receive speedier expert input without the need for patients to attend unnecessary clinic appointments.
GPs use dermatoscopes to take photos using the PhotoSAF (Consultant Connect App) of the concerning lesion, which the images and notes are saved to a secure cloud. The photos are then securely transmitted to a consultant dermatologist. Within 48 hours, the hospital consultant will have reported back – either reassuring that the lesion is benign and so no secondary care appointment needed, or inviting the patient in for a face to face consultation.
Functionality
- Photos of patients’ skin are taken using the PhotoSAF feature within the Consultant Connect App
- Photos are then included on the eRS two-week wait referral
- Capabilities
- Telephone and photo advice and guidance
- Images and notes are stored automatically in an IG secure and GDPR compliant cloud and not on the phone
- Images and a pdf summary are sent to the clinician’s NHS email address and can be downloaded to a computer
- Save images to patient records or sent to other clinicians via email or local referral systems
Scope
- Securely store and forward photos from patients direct to NHS consultants for photo advice and guidance
- Clinicians can take photos with the app during face to face consultations and share them
Key figures/quotes
- From project launch on 1 June 2018 to 30 September 2019, the outcomes have been positive, and the service continues to evolve with further refinement being made
- Of the 12,294 skin referrals received by LTHT from across the city of Leeds during this period, 8,261 (67%) patients have been clinically assessed using teledermatology. This is now consistent month on month. Work is ongoing with primary care to further enhance this
- All patient images are assessed by a consultant dermatologist within 48 hours of referral
- Consultant time for this first intervention is decreased through clinical assessment of images as this intervention takes between 30 seconds to 2 minutes (av. 75 seconds) as opposed to a face-to-face clinic appointment of 12 minutes
- There is an increasing proportion of patients discharged following image clinical assessment. The confidence of the team is increasing as consultants become more experienced. At the outset, the rate of discharge back to the GP on image assessment was 9.5%, which has increased to 33% in September 2019, meeting the original business case assumption
The Consultant Connect project in Leeds also featured in a HSJ article.
Teletriage service for two-week wait referrals
Read the full case study on NHSX website or we have replicated it below:
In order to more effectively manage the increasing number of dermatology two-week wait skin cancer referrals (150 a week) a teletriage service was developed by County Durham and Darlington NHS Foundation Trust (CDDFT) for all 2-week wait referrals to dermatology and plastic surgery.
Situation
The teletriage service required the primary care teams to be able to take good quality photos securely and send them securely via e-RS. Digital solutions were required to ensure that GPs had rapid access to cameras which could securely take patient images and allow easy transfer to the patient record and the e-Referral Service (e-RS), ideally using their own personal mobile device.
Aspiration
The aim was to make the two-week wait triage service accessible for all patients requiring urgent appointments for squamous cell carcinoma and melanoma, and to streamline the patients’ skin cancer referral pathway.
Solution and impact
It was decided that clinical commissioning groups (CCGs) would provide all practices with a dermatoscope and access to a secure smartphone app to take photos.
All GP practices were provided with an iPhone 10 with a Heine 20 dermatoscope and bracket.
Practices in CCGs using Consultant Connect technology were provided access to the Consultant Connect PhotoSAF App to download. Each GP was asked to register for a unique account with Consultant Connect using their NHS email address and a unique password.
Subject to patient consent, for each two-week wait referral the GP or other practice staff take three photographs of the lesion (dermoscopic, macroscopic and localising images). The images can then be downloaded to the patient’s primary care record from the Consultant Connect web portal via a secure login and password combination, either by the GP or any authorised member of their team. The three photos are then uploaded into e-RS with the two-week wait referral letter.
All two-week wait referrals made using this pathway are booked into a virtual clinic (CAS) managed by the CDDFT patient booking team. The responsible consultant logs into e-RS every day to check for new referrals. The photographs allow the dermatology team to triage the patient effectively or redirect to plastic surgery or maxillofacial surgery. The dermatology team identifies poor quality images and this data is shared by the Trust with CCGs to identify practices where further training may be required.
Roadshows and time out sessions were carried out across five localities to train GPs and practice staff to use the equipment and take high quality photos. The Trust agreed to change job plans to allow dermatologists adequate time to triage the referrals.
The Consultant Connect App is also increasingly used by GPs to send images to the Trust via e-RS Advice and Guidance.
Functionality
The Consultant Connect information governance (IG)-secure platform makes it easy for clinicians to take photos with the Consultant Connect App and attach them to referrals sent via the NHS e-Referral Service. Images and notes are stored automatically in an IG secure cloud (not on the phone). Images and a pdf summary can be downloaded by clinicians or administrative staff from photosaf.com.
Scope
The Consultant Connect PhotoSAF app:
- is designed for clinicians to share images
- allows the clinician to add NHS number and accompanying comments to the images
- stores images securely and prevents unauthorised people from accessing the images on the mobile phone
- automatically compresses each image to 5MB or less to comply with e-RS file size limits
Teledermatology using e-Referral Service advice and guidance at the Royal Devon and Exeter Hospital
Read the full case study on NHSX website or we have replicated it below:
The Royal Devon and Exeter Foundation Trust provides integrated health and care services to around 450,000 people in Exeter and across East and Mid-Devon. The Exeter dermatology department provides a wide variety of services, including teledermatology (advice and guidance provided remotely to GPs), outpatient clinics, skin surgery and phototherapy.
Situation
Increasing referral volumes to the dermatology outpatient clinic and long waiting time.
Aspiration
Using e-RS A&G to effectively manage outpatient clinic capacity.
Solution and impact
The Royal Devon and Exeter Hospital (RD&E) dermatology department has been providing advice and guidance (A&G) teledermatology service since 2011 using the e-Referral Service (e-RS). The service received approximately 150 A&G requests a month prior to the COVID-19 pandemic, but has been receiving 250 to 300 requests a month since June 2020.
Six consultants provide the teledermatology service; each provides A&G on one day a week and has allocated time in their job plan. All reporting consultants have been allocated a Trust laptop to allow remote access. A&G requests are responded to within two working days (most within 24 hours). The teledermatology service accepts A&G requests for all skin conditions in adults and children with the exception of pigmented lesions and two-week-wait requests. The majority of A&G requests relate to inflammatory skin disease and pre-cancerous skin lesions.
A&G provides a valuable educational teledermatology image bank for teaching healthcare professionals. The department provides a parallel e-RS Referral Assessment Service (RAS), allowing referred patients to be triaged to the correct subspecialty clinic (phone, video or face-to-face), or direct to surgery with a pre-operative phone consultation.
Implementation
Mobilisation of the teledermatology A&G service has followed the principles of the NHS A&G toolkit. Wider roll-out of A&G across other specialities (including cardiology, gastroenterology, neurology, endocrinology and gynaecology) formed a key workstream for the Trust in April 2018/19 following the national CQUIN for A&G. The Consultant Connect PhotoSAF app has been commissioned across Devon to allow primary care clinicians to use their own smartphones as secure cameras to photograph and upload patient images to e-RS.
Teledermatology A&G provides secure, rapid, two-way digital communication between GPs and the dermatology team, and provides a safety net for patient care during COVID-19 recovery. The Trust and clinical commissioning group (CCG) collect monthly data on:
- the number of A&G requests
- the number of patients seen in the dermatology department for a face-to-face consultation within six months of their A&G
A&G teledermatology has:
- reduced unnecessary hospital outpatient referrals (<20% of A&G requests result in the patient being referred to outpatients within six months of their A&G)
- helped ensure that patients requiring face-to-face appointments are seen in the right place at the right time by the right person
- improved communication and education between primary and secondary care
Main barriers to change
To encourage GP engagement the CCG allocated a senior information analyst from an existing primary care commissioning role to visit local GP practices that required additional support to start using the A&G facility of e-RS (this support is now available via the A&G national toolkit).
A&G usage among GP practices varies according to the availability of digital technology and their willingness to use it. Before the release of the Consultant Connect photoSAF app, rapid access to cameras was a barrier for GPs.
Functionality
- Allows a clinician (such as a GP) to seek advice from another (such as a consultant) before, or instead of, making a referral
- If a specialist recommends referral as part of their advice, the referral decision and responsibility remains with the GP
- New e-RS functionality in 2021 will allow providers to directly convert an A&G request into a referral if the GP has given pre-authorization
- Advice and guidance should run in parallel with referral services; supplementing, but not replacing them
- Enabling access to specialist opinion helps GPs or other referrers to manage patients in the community and avoid unnecessary referrals
Capabilities
- Provide digital communication between two clinicians
- Ask other clinicians or specialists for their advice on a treatment plan and/or ongoing patient management
- Gain clarification or advice regarding a patient’s test results
- Seek advice on the appropriateness of a referral for their patient (for example, whether to refer, or what alternative care pathways exist)
- Identify the most clinically appropriate service into which to refer a patient
Scope
- A referrer can send advice requests and attach documents such as diagnostic results, clinical photos, scanned images or previous correspondence relating to the patient
- A provider is then able to review the request and its attachments before responding to the query, with more attachments of their own. These attachments could include a proposed treatment plan or links to external documents and websites
- The referrer is able to convert the advice request into a referral or appointment request, linking the advice information and any attachments to the referral. This ensures that the receiving provider has all the relevant referral information and eliminates the need for a new referral to be created
- NHS e-RS is available to all GPs, dermatologists and hospital trusts in England, with no set‐up costs, providing the potential to rapidly and cost-effectively reduce face-to-face referrals and provide care closer to home
Key figures/quotes
The service received approximately 150 A&G requests a month prior to the COVID-19 pandemic, but has been receiving 250 to 300 requests a month since June 2020.
