Consultant Connect’s teledermatology project at Leeds Teaching Hospitals NHS Trust is working to speed up diagnosis of skin lesions and reduce demand on the 2WW pathway. Photos of patients’ skin are taken using the PhotoSAF feature within the Consultant Connect App and the photos are then included on the eRS 2WW referral. The PhotoSAF feature met Leeds’ requirements – particularly around information governance, compliance and ensuring the new process worked for both primary care and secondary care. Because it’s so simple, GPs didn’t need any training to get started.
LATEST project data at a glance:
- On average 67% of patients are clinically assessed using teledermatology
- The percentage of patients discharged back to the GP now 33%
- All patient images are assessed by a Consultant Dermatologist within 48 hours of referral
- Consultant time is saved – triage now ranges from 30 seconds to 2 minutes
The project has been so successful that The British Association of Dermatologists (BAD) have included it as a case study (page 4) in their highly regarded ‘Dermatology Outpatient Case Studies’ paper – click here to download the pdf: BAD Outpatients Case Studies Dec 2019. We have replicated the Leeds Teaching Hospitals NHS Trust case study below:
Using Technology to Enhance Service Delivery
Teledermatology: Leeds Teaching Hospitals NHS Trust
What is the aim of the service?
It is a means by which GPs can send images of suspicious lesions to consultants, resulting in a speedier diagnosis, and resulting in many patients being able to be discharged without attending hospital. The project is part of the Leeds Cancer Programme which sees Macmillan Cancer Support, Leeds Teaching Hospitals NHS Trust and NHS Leeds CCG working together to transform cancer services across the city.
What were the main drivers for change?
- National shortage of consultants
- Majority of lesions sent via 2ww pathway were benign
- By tackling the ‘benign’ lesions referred, we hope to increase capacity across dermatology both for urgent and routine appointments
The drivers for developing this system were a 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.
A pilot study was carried out to test the hypothesis. GPs were provided with specialist magnifying devices which enabled them take images of the lesions using a smart phone or tablet. They sent images to Walayat (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 that they were already familiar with. 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.
What were the main barriers to change?
- Resistance with any new pathway or change to an established system
- GP engagement was crucial for this to work – establishing GP champions to promote the system to their colleagues was key
- Funding for dermatoscopes etc. was an issue, but funding was obtained via early cancer diagnosis grant from West Yorkshire and Harrogate Cancer Alliance
- GDPR method of image transfer from primary to secondary care (easily overcome via use of Consultant Connect App)
What has been the impact of this service improvement project?
From project launch on 1st June 2018 to 30th September 2019, the outcomes have been positive, and the service continues to evolve with further refinement being made. To date:
- 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
For more information on how this service could support your NHS area, please contact us on 01865 261467 or email hello@consultantconnect.org.uk
