Supporting Patients with Suspected Skin Cancer During the Pandemic
by Luton and Dunstable University Hospital , Bedfordshire Hospitals NHSFT
Following the national lockdown in March 2020, Luton and Dunstable University Hospital (Bedfordshire Hospitals NHS Foundation Trust), had to find a remote solution for patients referred with suspected skin cancer. These patients experienced considerable anxiety, which was compounded by worry about infection risk. The answer had to align with government guidance for two week wait (2WW) cancer pathways, be clinically safe and not introduce delays in patient management. The result was a novel, digitised end-to-end web-based teledermatology solution, using the Pathpoint eDerma platform. Despite losing staff through redeployment, shielding and lack of locum doctors from abroad, the 2WW pathway continued, with high levels of patient and clinician satisfaction. A total of 43% of 2WW referrals were assess though eDerma using only two staff members, with excellent outcomes and high levels of patient satisfaction. Face-to-face consultations were provided for 57% of referrals, plus urgent cancer treatments, with strict infection control measures. For the first three quarters of the financial year 2020/21, the service was underspent on staffing costs by £184,000. Without eDerma, the service would have had severely restricted capacity for non-cancer pathways.
"The work from Luton and Dunstable University Hospital, Bedfordshire Hospitals NHSFT had a clear focus on innovation and outcomes in an area of dermatology where you really can’t afford to get it wrong. The method and innovation submissions deal critically with the problem at hand. Even though they lacked staff they were still able to provide a service which was critical during the pandemic, clearly supported by the technology that they employed. They had also made allowance for non-tech users. A strong and outstanding project."
Teledermatology to Manage Skin Lesions During the COVID-19 Pandemic
by Ipswich and East Suffolk CCG
In April 2020, Ipswich and East Suffolk CCG commissioned Vantage’s Rego Teledermatology system to provide an innovative technological solution for supporting faster diagnosis and management of skin lesions and reducing unnecessary referrals to secondary care, both during the COVID-19 pandemic and afterwards. The system enables consultant dermatologists at Ipswich Hospital to triage patients and provide rapid advice and guidance to general practice by utilising static digital images to assess the skin condition without the patient being physically present. Since going live in June 2020, over 880 advice and guidance requests have been sent through Rego and 46% of cases have been managed in primary care, providing faster diagnosis, and avoiding long waits and uncertainty for patients. Over 100 patients, who would otherwise have been waiting many weeks to be seen in a routine clinic, have been fast-tracked into a two week wait (2WW) appointment for faster cancer diagnosis and treatment. A strong collaborative approach between primary and secondary care has been important to the project’s success. The team is continuing to work together to develop a Teledermatology 2WW pathway, which will enable suspected cancer referrals to be triaged and managed more effectively.
"Ipswich and East Suffolk CCG’s project demonstrates clear innovation in a service fraught with access difficulties, with good links between primary and secondary care. Its streamlining of services that delivered equitable access to dermatology services for all. There was good identification of key stakeholders and the necessary processes to undertake changes and timelines for project delivery were clear, with good safety considerations."
MySkinDoctor – Patient Led Teledermatology
by MySkinDoctor in collaboration with Sussex Community Dermatology Service
The consultant dermatologists at Sussex Community Dermatology Service, with significant experience and backgrounds in healthcare economics, decided to seek a solution to long patient waiting times and a consultant shortage of over 100 posts nationally. They engaged with patients, GPs, consultants and CCGs to develop the digital health solution, ‘MySkinDoctor’. MySkinDoctor is an online, patient-led mobile app which allows patients to access dermatology services remotely without the need to visit a clinic. It provides swift, efficient triage, with patients receiving a personalised care plan, including a diagnosis, condition information and a treatment plan within three working days, without having to leave their homes. This information is also communicated to the referring GP and included on the patient record. In contrast, traditional teledermatology is inefficient, requiring patients to attend longer, or additional, clinic appointments for assessment with a dermatoscope carried out by a GP or clinical photographer.
"The judges were impressed that this project was clearly patient led and innovative. The whole entry was well developed and implemented. It scored highly on innovation, effectiveness and sustainability. This is desirable. How do you control access to it? In terms of an innovation it was transformational."
Digital Assessments for Specialist Adult Psoriasis and Eczema Outpatient Services
by St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust
Biologic medications have revolutionised the treatment of psoriasis and atopic dermatitis, with sustained growth in the number of patients under biologic care. Early identification of stable patients in remission can free capacity, accommodate patient-initiated follow-up and manage complex cases. Following patient engagement and through a Care Redesign programme at St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust, a pilot digital assessment service was developed for the psoriasis service. This had been validated, but not implemented, in early 2020. The COVID-19 pandemic led to the adaptation and widespread implementation of digital assessment across all psoriasis and eczema outpatient services in April 2020. This expedited the revision of the biologics pathway and permanent integration of virtual consultations into the remission pathway. These assessments were also piloted as substitutes for telephone consultations.
The changes have increased efficiency while maintaining quality, allowing continuation of all follow-up services throughout the pandemic. Virtual review is now a permanent part of the care pathways.
"Right from the beginning this entry clearly highlighted the need for the project and its outcomes. It is a non-face to face virtual service, with a good rational around the project planning phase and a strong service re-design. There were good safety considerations regarding risk and clinical governance."