Retaining dermatology patients in primary care using dialogues with secondary care: A service evaluation

BackgroundWait list sizes for specialist secondary care have soared in recent years. Dermatology is a good candidate service for retaining patients in primary care and avoiding unnecessary waits to see a specialist. A dermatology dialogue service between primary and secondary care (DDPS) was developed in Norfolk and Waveney, eastern England. The service involved primary care referrers uploading patient images of skin complaints for review by and dialogue with secondary specialists to see if the patient could be retained in primary care, or should be referred to secondary care routinely, urgently or on the two week wait cancer pathway. ObjectivesTo evaluate service performance with respect to specific targets including reduction in secondary care wait list growth in the period March 2021-March 2022 inclusive. MethodsService activity was summarized with respect to speed of resolution, case counts and dispositions. Clinician and patient satisfaction were canvased with structured questionnaires. Actual new referral counts were compared to projections based on historical data. Wait list growth was compared to other specialisms and other areas. Wait times to receive first treatment at start and end of monitoring period were monitored. ResultsOver 3600 patients were enrolled in the DDPS system. Over 98% of cases were reported by the dermatologists within 36 hours. Clinician and patient satisfaction were high. Frequently asked questions and conditions were highlighted by dermatologists to design and deliver an educational event for primary care clinicians that was well received. Wait list growth to see dermatology in the commissioning area was smaller for dermatology than other large specialisms, and mostly smaller growth than dermatology wait lists commissioned by other NHS commissioners. Negative impact on the urgent priority (cancer pathway) wait list could not be observed. ConclusionsThe DDPS was satisfactory to clinicians and patients and coincided with smaller dermatology wait list growth than might otherwise have been expected.