Transforming dermatology outcomes using digital technology: results from teledermatology pilots in London and the south east

Skin conditions are a growing concern in the UK; more than 100,000 new cases of skin cancer are reported every year, with rates of some skin cancers growing by up to a third in the past decade. About one in four people consults a GP about a complaint related to their skin each year.

Patient pathways related to skin conditions are often complex and slow-moving. Referrals may take weeks or even months to complete, leaving patients in pain or worrying without a clear diagnosis from dermatology specialists in secondary care. Improving the referral journey for dermatology was highlighted as a priority in the NHS Long Term Plan.

Teledermatology refers to the use of static digital images to triage, diagnose, monitor or assess skin conditions. The use of teledermatology has the potential to significantly improve patient pathways through benefits such as:

• Allowing specialist clinicians to review certain types of skin condition remotely and provide self-care advice for lower-acuity issues without waiting for a face-to-face appointment;
• Using images to triage new patients more effectively, potentially reducing the number of appointments needed for diagnosis;
• Monitoring the changes in skin conditions over time, or allowing patient records to include details of “flare ups” in certain conditions.

Dermatology Improvement Collaborative

Beginning in 2020, the HIN delivered a programme of support for dermatology services across both south London ICSs and Surrey Heartlands ICS to help them implement innovative digital solutions and ensure patients are seen in the right clinic the first time.

This Dermatology Improvement Collaborative – supported by the Industry Dermatology Initiative (IDI) – produced an initial report in 2021 looking at some learnings from the first phase of the project. However, the impact of Covid-19 meant that implementation of many aspects of the programme were delayed.

A second phase of the project was then commissioned, providing scope for developing a deeper understanding of the impacts, challenges and learnings related to a variety of teledermatology projects run across the regions. Some of these projects included:

• Provision of image capture devices/dermatoscopes in primary care;
• Development of new teledermatology pathways at ICS level using medical photography;
• Setting up referral support services using smartphone images to triage routine skin conditions.

A full report is now available to download providing in-depth analysis of each of these transformation projects and their impact on key outcomes. The key themes and recommendations identified by the report include:

• Reduced needs for secondary care appointments: implementing teledermatology into advice and guidance requests often meant that patients could be discharged or managed in primary care, reducing the need for secondary care appointments. When appointments did take place, they were often shorter;
• More patients seen in the right clinic more quickly: virtual triage appears to allow for redirection of referrals onto the appropriate clinical pathway with fewer delays;
• Considerations for spread and adoption: including working at regional level to develop standardised approaches to implementation, addressing technical challenges, workforce planning, and successful engagement with primary care.