Teledermatology

Teledermatology is a means by which GPs can send images of suspicious lesions to consultants, resulting in a speedier diagnosis and in many patients’ discharge without attending hospital.

The project is part of the Leeds Cancer Programme which sees Macmillan Cancer Support, Leeds Teaching Hospitals NHS Trust and NHS Leeds CCG working together to transform cancer services across the city.

How was it developed?

The drivers for developing this system were a shortage of consultant dermatologists and an increase in the number of skin cancer referrals from GPs. Walayat Hussain, consultant dermatologist at Leeds Teaching Hospitals looked at the data about patients referred by GPs and subsequently discharged without a clinical intervention: this amounted to about one third of the referrals. This led to the thought that decision-making should be enabled without the patient needing to visit hospital, with a possible solution offered by GPs sending images of suspicious lesions to the consultants.

A pilot study was carried out to test the hypothesis. GPs were provided with specialist magnifying devices, which enabled them take images of the lesions using a smart phone or tablet. They sent images to Walayat (identified only by the NHS number) but also referred the patient through the normal pathway. Walayat compared his diagnosis based on the image with the outcome of the face-to-face consultation: in every case the diagnosis was the same.

The evidence led to national cancer transformation funding provided via the West Yorkshire and Harrogate Cancer Alliance.  A steering group with representatives of every organisation on the pathway was established to progress and oversee the project.

Who is using it?

All GP practices in Leeds are now using the imaging system, which works via the Consultant Connect App that they were already familiar with. Supporting material and videos were used to explain the system to GPs and to patients.  The imaging process that needs to be done by the GP takes just 30 seconds, so does not adversely affect GP appointment times. After getting patient consent, the GP takes three images to send to the hospital.

Outcomes

The service reports that imaging has led to 25-30% of patients now being discharged by the GP within two days of their GP appointment. Had these patients gone through the normal referral procedure it would have been two weeks before they were seen. It is also said to save consultant time as each of those referrals would have required a consultant appointment, as well as more administrative time.

Commenting on how services had been designed to meet the needs of local people, a CQC report published in February 2019 gave this service as an example: ‘To avoid patients having to travel unnecessarily to the site for a consultation with the consultant, there was telephonic dermatology service for skin cancer. Patients now saw their GP if they had concerns about any type of mole or lesion. The GP could take a photo and the dermatology consultant on site would review it and supply advice or an urgent appointment.’ The trust was rated good.