Implementing safe and effective teledermatology triage pathways and processes can reduce waiting times, footfall into Community Services and Acute Trusts, and improve patient outcomes. We delivered a three-part programme for NHSX to assess whether teledermatology could deliver its 10% waiting time reduction target.
Annually, 24% of people see their GPs for skin disease resulting in around 3 million consultations with only 650 dermatologists working in the system. COVID-19 has increased pressure on dermatology services and there are also increasing incidences of skin cancer which both place a greater strain on limited dermatology resources.
Enter teledermatology, with the ability to create efficiencies in the dermatology pathway and so release clinical capacity and improve patient access. What it does is provide an opportunity to capitalise on digital opportunities to streamline the dermatology pathway through remote image sharing and enhanced referral practices (Advice and Guidance).
Challenge
Amidst the crisis in dermatology care, in January 2021, regions were invited to apply for funding via an Expression of Interest (EoI) process to access almost £5m of NHSX central investment for teledermatology programmes.
Once this funding had been allocated it was going to be important for NHSX to be able to measure the impact of this investment. Was their target of a 10% reduction in waiting times by the end of the financial year 2021/2022 in all settings as a result of the investment going to be achievable?
To measure the impact and outcomes of the teledermatology programme NHSX originally planned to collect the data themselves via regionally disseminated metrics proformas written in Excel. A number of challenges became apparent:
- Regional colleagues varied in their level of familiarity with nationally published data sets and how to interpret them
- There were variations in how the data is presented, in regional returns
- Variations also existed in timelines around data especially as it needs to sit within a monthly and quarterly reporting structure
- Lack of availability of resources within regions due to the current workforce issues around managing the Vaccination Programme and Pandemic
- The reliance on the use of MS Excel to collate, store and present the data
Approach
SCW was asked to deliver a solution to track implementation progress and measure outcomes for NHSX. This would result in producing documentation to help publicly explain the outcomes of the work. Our support was divided into three packages:
1. Metric Measurement – Working collaboratively to devise and pre-populate a new collection template disseminated to ICSs on a monthly basis for validation and sign-off for the following relevant metrics:
- Advice & Guidance requests (A&G) / Outpatient First Appointments (OPFA)
- Total number of appointments
- Total number of referrals
- Average 2WW standard performance
- Average 18-week RTT standard performance
2. ICS Specific Case Studies – Supporting ICSs to develop case studies detailing and sharing the impact and benefits from the services, resources and equipment purchased from the teledermatology programme to include pathway review and redesign, and particularly patient stories.
3. Programme governance - A monthly steering group was established to bring regions together to check progress and share their experiences. On an ongoing basis this will develop into a forum to learn from each other about how the investment has been able to impact and support patients and clinical teams.
Impact
Getting real-life experiences of how this investment has impacted patients and clinical teams is the crucial measure of success of this programme. Initial feedback includes:
- Bringing limited resources together across a region/pooling resources to provide a central more efficient virtual service
- A project focused on developing GP training sessions has received positive feedback from all attendees with an observable improvement in quality of images taken following their participation
- Following the launch of a redesigned teledermatology pathway and subsequent educational events, one area experienced an increase of referrals received to secondary care with an image attached from 1% to 50%.
- Successful targeted communications campaign to a group at highest risk of skin cancers (male outdoor workers under 50) that has since been rolled out by a large building contractor to all of their building sites across the UK.
- Project to roll out of dermatoscopes and adaptors to all GP practices in one ICS has received positive feedback on their ease of use and the speed of return for Advice & Guidance from secondary care (1-2 days)
For more information on our Teledermatology work, email This email address is being protected from spambots. You need JavaScript enabled to view it.
