A 3-year review of an innovative teledermatology service in paediatric dermatology delivering results in the face of a pandemic backlog

ABSTRACT

The COVID-19 pandemic has shifted the paradigm of healthcare delivery within the National Health Service;a focus on virtual care and increasingly limited healthcare resources has led to the use of telemedicine platforms to help streamline referral pathways and deliver care. Within our paediatric dermatology service we have employed the teledermatology platform, Consultant Connect (CC), to deliver advice and guidance, and triage referrals. In addition to improving care and patient outcomes through the platform, its continued development is vital to meet future healthcare requirements. NHS England (NHSE) have outlined expectations for significant reductions in follow-up activity and increased service productivity over the next 2-3 years in their recent priorities and operational planning guidance. We undertook a service evaluation of referrals to the CC platform, which was established in 2019 as a pilot to support general practices outside our catchment area, with advice and guidance for paediatric dermatology. In 2020 this was expanded to cover our local Clinical Commissioning Groups. We aimed to ascertain how well the CC service is achieving its goal, which is to provide rapid response to general practitioners (GPs) and streamline our referrals directing them to either, hospital, community or urgent referral pathways. From July 2019 to January 2021, 2080 referrals were made to CC. In 1540 (74.2%) of cases, onward referral to either community or secondary care was avoided. Further recommendations were as follows referral to community dermatology (0.4%), routine referrals to secondary care (16.7%), urgent referrals (1.9%) and 2-week wait referrals (2.0%). Insufficient or inadequate clinical information was identified in 0.5% of cases. The average response time was 44.5 min. Since service initiation, the number of referrals per week has increased from seven to 80 (91% rise). The majority of referrals had inflammatory diagnoses (49%), followed by infective dermatoses (20%). Our evaluation demonstrates the growing demand for a teledermatology service and its success in offering timely, high-quality advice to GPs. With defined diagnostics and management plans, GPs are able to initiate treatment in the community, and referrals can be streamlined appropriately. NHSE aims to create two-way digital advice and guidance between clinical teams, ensuring patients are managed safely and referrals triaged according to clinical priority. The CC service not only addresses the immediate task of recovering from the pandemic by clearing waiting lists, but also offers innovative solutions for driving up quality of care for growing numbers of patients.