BT01 Taking pressure off the skin cancer service: impact of primary care dermoscopy pilot, medical photographer-led clinics and non-2-week-wait skin lesion advice and guidance pathway

Abstract

Abstract Since the COVID-19 pandemic, we have struggled with similar pressures and capacity issues as most dermatology departments across the country. Our number of 2-week-wait (2WW) and general referrals have increased by 26%. To manage this, we have gradually introduced strategies based around a triaging system for 2WW referrals received with photographic images from the general practitioner (GP) via the National Health Service e-Referral Service (e-RS). We triage patients either to a face-to-face 2WW clinic, a spot clinic run by supervised junior members of the team or a photography/dermoscopy clinic. If we receive dermoscopic images with the GP referral, where appropriate, we can discharge or downgrade the patient to a routine clinic. Strategy 1: in September 2021, we set up a 1-year primary care 2WW dermoscopy pilot. Dermatoscopes were delivered to interested GP practices (appropriate technical training was provided), and the GPs attended skin lesion teaching sessions every 2 months. Thirteen per cent of all our 2WW referrals came through this dedicated pilot 2WW e-RS pathway. We discharged or downgraded 26% of those that were referred with both macroscopic and dermoscopic images. All GP practices (not just the pilot practices) in our region now have dermatoscopes. Strategy 2: in July 2022, we introduced secondary care photography/dermoscopy clinics run by both dermatology nurses and medical photographers using the Pathpoint/eDERMA platform. We triage patients from 2WW e-RS referrals with macroscopic images suggestive of benign lesions to these clinics. We can discharge or downgrade directly from the platform, which immediately sends patients’ information about their diagnosis and management plan via text message. Around 15% of 2WW referrals are booked to eDERMA clinics and around 60% are discharged. Strategy 3: in October 2022, we developed a non-2WW advice and guidance (A&G) e-RS skin lesion pathway for lesions of diagnostic uncertainty and basal cell carcinomas. Dermatoscopic images are not an essential requirement as this is not a 2WW pathway. Referrals are triaged within 72 h, providing rapid advice to GPs. Initial data show that since introducing this service, 2WW referral numbers decreased by 32%. Of the A&G referrals, 28% were discharged with advice and 17% were upgraded to 2WW. Within 3 months of starting this pathway, our department’s 2WW and Faster Diagnostic Standard 28-day cancer targets were no longer breaching. The combination of GP-based photography and dermoscopy, careful triage to a 2WW photography clinic in secondary care and a non-2WW lesion A&G pathway has significantly improved our 2WW service.