Unlocking the Potential of Teledermatology
In the complex landscape of healthcare, dermatology often finds itself at the intersection of necessity and scarcity. With over 2,000 known skin diseases, the demand for dermatological services within the United Kingdom is substantial. The British Association of Dermatology (BAD), along with other associations such as the Primary Care Dermatology Society (PCDS) and the British Dermatological Nursing Group (BDNG) have been steadfast in their mission to provide comprehensive care for patients grappling with skin-related concerns.
Dermatology is undeniably an essential branch of medicine, 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, there were more than 3.5m outpatient and day surgery attendances in dermatology. Skin cancer now accounts for half of all cancers in England and Wales and is increasing by 8% annually and NHS dermatology units carry out around 200,000 procedures to surgically remove malignant moles, lesions and tumours every year [GIRFT Dermatology report Aug 21]. Dermatology is the sixth most sought-after specialty in terms of patient volume.
One glaring issue that stands out is the shortage of consultants in this vital specialty. Shockingly, ten NHS Trusts do not have a single dermatology consultant, compounding the challenges faced by patients and the healthcare system as a whole. Dermatology suffers from a significant workforce shortage. The GIFT report showed there were 659 consultant dermatologists 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.
With waiting lists for dermatology currently at over 380,000 people waiting over 18 weeks, the service continues to struggle to clear its backlog of incomplete pathways.
The Rise of Teledermatology
One of the most notable advancements in dermatology services has been the introduction of teledermatology. This innovative approach has already begun to revolutionise patient care.
Teledermatology can improve patient’s access to care due to the flexible nature of procedures being digital, whilst increasing capacity for the dermatology workforce, with the ability to digitally triage, diagnose, monitor or assess skin conditions without the patient being physically present. It provides one of the best possible options and can be disseminated much further and wider than any face-to-face service could ever provide.
Other opportunities to improve the patient experience can be identified 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’ rates – £9.1m
- Increased use of telephone consultations – £3.2m
One new 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.
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 per cent of referrals lead to a diagnosis of melanoma and squamous cell carcinoma cancers.
This model could generate savings of up to 75 per cent in specialist clinical time spent in face-to-face consultations for urgent cancer referral patients.
Conclusion
Dermatology services within the NHS are grappling with unprecedented demand, a shortage of consultants, and the need to adapt to the evolving landscape of healthcare. Teledermatology, when used effectively, can alleviate some of these challenges. 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.
It is 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.
CSL works with clients to understand waiting times at Trust level, adding context as to why sales targets might not be achieved. Read more in our article here: Why are we waiting? – Understanding Hospital Waiting Times.
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