Teledermatology in England

The Getting It Right First Time (GIRFT) national report highlights that one in four people in England and Wales (13.2m) see their GP about a skin, nail or hair condition every year. 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 that 659 consultant dermatologists were working in the NHS in England (508 whole-time equivalents), with 159 WTE consultant vacancies and more than 140 locums at the time of the review.

Consultant dermatologist Dr Natalia Spierings explains: The pressure on NHS dermatology departments has grown year on year, in the post-COVID era and 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.

Overall, the GIRFT report identifies opportunities to improve the patient experience by 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 new policy that could significantly save NHS system capacity is the Teledermatology virtual urgent skin cancer two-week wait (2WW) pathway. Approximately 460,000 patients are referred annually 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.

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, NHS Improvement (NHSE/I) 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.

In response to a questionnaire by GIRFT to 117 NHS Trusts, only 30% reported that their local teledermatology services are adequately and safely integrated with their services. 52% said their local teledermatology services are not adequately and safely integrated with their services. 18% had no local teledermatology service at all.

During a Health Select Committee, Dame Cally Palmer, the national cancer director for NHSE/I shared a new forward approach to ensuring teledermatological services are in place. She explained: “We have a comply or explain policy in asking trusts, ‘Have you got teledermatology in place’ to ensure, particularly with challenged trusts, that teledermatology is in place. That can make a big difference to the product, swift movement of patients through that pathway.”

In conclusion, it remains vital that England’s dermatology services are still viewed from a bird’s eye view to ensure its primary issues are not neglected. It remains positive, however, that, in the face of these challenges, work is being done to develop impactful technological solutions to keep the NHS moving forward.