Teledermatology set to support overstretched service

With waiting lists for dermatology currently at over 380,000 people waiting over 18 weeks, the service continues to struggle to clear the backlog of incomplete pathways brought about by a myriad of issues, most notably the COVID-19 pandemic, the cost-of-living crisis, and ongoing winter pressures on the NHS.

The Getting It Right First Time (GIRFT) national report highlights that one in four people in England and Wales – around 13.2 million people – see their GP about a skin, nail, or hair condition every year and in 2018/19 alone there were more than 3.5m outpatient and day surgery attendances in dermatology.

But, in the face of such numbers, dermatology suffers from a significant workforce shortage.

The same report shows there were 659 consultant dermatologists working in the NHS in England – 508  whole-time equivalents (WTEs) – with  159 WTE consultant vacancies and more than 140 locums at the time of the review.

But teledermatology can improve patient access to care due to the flexible nature of procedures being digital, while increasing capacity for the workforce, with the ability to digitally triage, diagnose, monitor, or assess skin conditions without the patient being physically present.

Consultant dermatologist, Dr Natalia Spierings, explains: “The pressure on NHS dermatology departments has grown year on year in the post-COVID era and is worsened by the lack of highly-skilled healthcare professionals available.

“The catch-22 is that the more pressure we face, the more likely we are to leave, which only adds to the pressure.

“Teledermatology provides one of the best-possible options and can be disseminated much further and wider than any face-to-face service could ever provide.”

The pressure on NHS dermatology departments has grown year on year in the post-COVID era and is worsened by the lack of highly-skilled healthcare professionals available

Overall, the GIRFT report identifies opportunities to improve the patient experience through establishing more-equitable access to treatment, fewer admissions, and fewer repeat visits.

This, in turn, will reduce the costs of common procedures and free up between £20m-£35.5m of NHS money through measures such as:

• Reducing outpatient follow-ups - £14.6m
• Reducing did not attend (DNA) rates – £9.1m
• Increased use of telephone consultations - £3.2m

One specific policy that could significantly save NHS system capacity is the Teledermatology virtual urgent skin cancer two-week wait (2WW) pathway, currently being delivered alongside the NHS by independent healthcare providers like Xyla Elective Care, part of Acacium Group.

Each year, approximately 460,000 patients are referred through the 2WW face-to-face referral pathway for GP-suspected skin cancers.

However, only around 6% of referrals lead to a diagnosis of melanoma and squamous cell carcinoma cancers.

This model could generate savings of up to 75% in specialist clinical time spent in face-to-face consultations for urgent cancer referral patients. This would equate to over 5% extra specialist capacity across the whole specialty.

Over several months working within the Norfolk system, Xyla Elective Care was able to implement teledermatology services to decompress pressures on the existing workforce resulting in over 60% of cases re-directed away from secondary care and a 48-hour turnaround of decisions.

There are a few different teledermatology models currently in use, but whichever model is adopted, I think we can all now agree that teledermatology allows us to use our limited workforce in a much-more-effective way

Commenting on the industry’s advances in teledermatology, Acacium Group’s healthcare services director, Nicola Ellis-Webb, said: “There are a few different teledermatology models currently in use, but whichever model is adopted, I think we can all now agree that teledermatology allows us to use our limited workforce in a much-more-effective way.”

NHS England and Improvement’s teledermatology Roadmap and The National Teledermatology Investment Programme (NTIP) are part of this focus on innovation.

Since its inception, the NTIP has funded 28 NHS clinical commissioning groups and seven NHS trusts across England, enabling them to put digital tools in place to help improve dermatology care for patients and shorten waiting times.