ABSTRACT
Amidst the COVID-19 pandemic, the National Health Service (NHS) faced unprecedented changes to patient care, with specialties having to adapt using technology. At the outset of the pandemic our dermatology department already had a waiting list of > 800 new patient referrals [excluding 2-week-wait (2WW) patients], owing to the impending release of a new electronic patient record ('MyCare') platform. By redesigning pathways and reallocating surgical resources to remote consultation clinics we observed a paradoxical explosion in efficiency. Within 10 weeks of the onset of 'lockdown' we had virtually cleared the waiting list to 18 patients (which had peaked at 950 patients), using a combination of teledermatology, telephone clinics and video consultations. A solution was devised by consensus in the department. Urgent cases and possible [non-basal cell carcinoma (BCC)] cancers were still seen face to face. However, all other appointments became virtual, using telephone consultations and emailing photographs in a patient-directed store-and-forward approach. Where surgical lists for non-urgent BCC surgery had been cancelled, clinicians were allocated remote-consultation clinics, with temporal and geographical flexibility for delivery within their current job plans. Patients were invited to send skin photographs to a shared departmental NHS.net account that was initiated by trainees, to supplement telephone consultations where required. Quality was assisted by explaining simple photography techniques in a default email signature (https://www.bad.org.uk/shared/get-file.as#x?itemtype=document&id =5818). The issue of consent was managed practically for the majority;the act of sending a photograph inherently implied consent. Where necessary, patients had the option of signing a bespoke teledermatology consent form sent as an email attachment, enabling images to be saved to their medical record if required. Additional resources of benefit include Attend Anywhere video consultations, and M-modal digital dictation. Furthermore, to manage new patients referred after onset of the pandemic, Consultants are e-triaging all non-2WW referrals through e-RS using a Referral Assessment Service - with e-RS Advice and Guidance being used routinely, too. Teledermatology during the COVID-19 pandemic has not only compensated, but has also highlighted some advantages over traditional patient pathways. Clinicians and patients alike quickly acknowledged that a telephone call could often suffice, if not preferable to meeting in person. With a large catchment area, many patients were pleased to avoid the long journeys. COVID-19 catapulted everyone into unchartered territories, posing innumerable obstacles in delivering good patient care. With simple measures, we emerged having tackled our already inflated pending list. What is more, the delivery of traditional model of care was questioned. Who knew you could see a dermatologist over the phone?