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Why consultant led teledermatology is about making better decisions, not just seeing patients faster
I have worked as a consultant dermatologist in the NHS since 2018, across a range of hospital and community settings. During that time, I have seen dermatology delivered in many ways: traditional outpatient clinics, insourcing models working alongside NHS teams, full service delivery and consultant‑led teledermatology.
What has become increasingly clear is that pressure in dermatology cannot be solved by speed alone. The real issue is how and when clinical decisions are made.
In some parts of the country, patients can wait a year or more to see a dermatologist. Understandably, the response is often to focus on throughput. More clinics, more appointments, more activity. But without the right clinical structure, faster pathways do not always lead to better care.
Not every dermatology referral needs a hospital appointment
Dermatology referrals vary widely in risk and complexity. A referral for a skin lesion might represent a serious cancer, or it might be a benign condition that can be safely managed in primary care with the right advice.
In traditional pathways, most referrals default into secondary care. This means large numbers of patients attend hospital appointments they do not need, while services struggle to protect capacity for higher‑risk patients.
Through my work with Xyla, I have seen how consultant‑led teledermatology changes this dynamic. Referrals are supported by high‑quality medical photography and reviewed by UK‑trained consultant dermatologists. Each case is directed to an appropriate outcome, including:
- Discharge back to the GP with clear management advice
- Urgent escalation for suspected skin cancer
- Prioritisation for routine or urgent face‑to‑face review
A significant proportion of patients can be managed safely without attending hospital. For those patients, teledermatology avoids long waits, unnecessary travel and prolonged anxiety. For the system, it reduces avoidable pressure on secondary care.
This is not about denying access. It is about directing patients to the right level of care from the outset.
Earlier clinical decisions improve access and experience
One of the most important differences teledermatology makes is when specialist judgement is applied.
In many traditional pathways, consultant input happens late. Patients can wait months before their referral is properly reviewed. During that time, uncertainty often increases anxiety, particularly where cancer is a concern or where visible skin conditions affect confidence and mental wellbeing.
Consultant‑led teledermatology brings decision‑making forward and allows:
- Earlier consultant review while patients are still waiting
- Faster reassurance where escalation is not required
- Earlier identification and prioritisation of higher‑risk patients
This can make a meaningful difference to patient experience and outcomes.
It is also particularly relevant for underserved communities. Barriers such as transport, work commitments, digital access and health literacy can all delay engagement with care. While teledermatology does not remove these challenges entirely, simplifying pathways and reducing unnecessary steps can make services easier to navigate for patients who already face disadvantage.
Using specialist time where it adds most value
As consultants, our most valuable contribution is clinical judgement. Yet in overstretched systems, a significant proportion of consultant time is taken up by activity that does not require that level of expertise.
Teledermatology allows specialist input to focus on decision‑making. In a single session, consultants can review a large number of referrals in a structured way, concentrating on assessment, risk stratification and management planning.
Alongside this, other models also demonstrate how consultant expertise can be deployed more effectively. High‑volume dermatology clinics, including cancer clinics, can allow large numbers of patients to be seen efficiently when the right infrastructure and support are in place. While these clinics are typically delivered in secondary care, they do not have to be if appropriate clinical facilities are available in the community.
Across all models, the principle is the same. Consultant expertise should be applied deliberately where it has the greatest impact.
Scaling services without losing sight of safety
Any model that allows dermatology services to operate at scale must be underpinned by strong clinical governance.
In my role as clinical lead for dermatology at Xyla, this includes oversight of safety, audit, guideline adherence and accountability across teledermatology, face‑to‑face care and insourced services. Complaints and clinical concerns follow established governance routes, with consultant oversight throughout.
Teledermatology does not reduce the need for governance. Clear escalation pathways, peer review and named consultant leadership are what make services safe as they grow.
What this means for commissioners
Teledermatology should not be viewed as a technology solution to waiting lists. It is a clinical service model that changes how specialist expertise is used.
When commissioning dermatology services, commissioners should prioritise:
- Where and when consultant judgement is applied
- How patients are directed to the right setting first time
- Whether governance and escalation are built in at scale
- Whether pathways reduce secondary care demand rather than shift it
Commissioned in this way, consultant‑led teledermatology supports earlier decisions, better prioritisation and more sustainable use of specialist resources.
In a system under sustained pressure, smarter decision‑making delivered earlier often matters more than speed alone.
See this approach in practice
Xyla partnered with Frimley ICB to cut dermatology waits from over 80 weeks to as little as 48 hours through a consultant‑led teledermatology pathway that reduced secondary care demand while improving patient experience.
Read the Frimley tele dermatology case studyGeneral information:
clinicalcare@xylaservices.com
020 4602 5691
If you are a patient of Xyla clinical care services please call our dedicated patient line, 0207 713 2756, and choose option 1.
If you would like to speak to a member of the recruitment team, please call 020 4602 5686.
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