1. Teledermatology Service ABUHB Natalie Stone, Caroline Mills, Richard Goodwin, ABUHB Medical Illustration, IT March 2016

2. Background Dermatology Crisis David Eedy BMJ June ’15 Kings Fund Report June ’15 ABUHB 600,000 15,000 refs/yr and rising Demand / capacity gap ; Unsustainable 6 consultants + 2 0.5 locums; then 3 + 0.2; now 5 + 0.2 (BAD guidance should be 9 wte consultants) Teledermatology ‘pilot’ 2013

3. GP e-referral Medical Illustration book photography appointment Consultant views photographs/ dermoscopy/ GP letter on CWS – digitally dictates letter to GP and patient DischargedBooked for OPABooked to Minor OpRef other specialty

8. 1. Outcomes? 2. Would GPs ‘over refer’ and use this as well as normal route? 3. Would patients like it? 4. Would diagnostic quality be as good as face- to-face? 5. Would ‘incidental’ lesions be missed? 6. Some patients will have telederm AND face- to face – will it be cost effective use of resource?

9. GP e-referral Medical Illustration book photography appointment Consultant views photographs and letter on CWS – digitally dictates letter to GP and patient DischargedBooked for OPABooked to Minor OpRef other specialty 50% lesions 75% gen/paeds 28% lesions 25% gen/paeds 22% lesions 1. Outcomes

10. The ‘Crocodile Graph’ 2. Demand

11. ‘Summer wave Graph’

12. 3. Patients happy?

13. The British Association of Dermatologists (BAD) led the project with a multi-stakeholder group: BDNG, British Society for Paediatric Dermatology (BSPD), PCDS, Royal College of General Practitioners (RCGP), commissioners, GPs, GPwSI, nurses and pharmacists, with input from the Department of Health 4. Quality 1.Double Reporting consecutive lesions 18/20 agreement 2.Diagnosis V Pathology; 30/39 cases (77%) concordance 5. ?Missed incidentals Yes but medical photographers excellent pattern recognition/good communication/ learning v fast!

14. Finance Business Intelligence Team (Mark and Zoe) ‘Time Driven Activity Based Costing Approach’ TDABCA Visited General; Lesion; Paediatric opds; Medical illustration Produced reports & asked for feedback Double the number of new patients able to be given an opinion in the a teledermatology sessions complared to a conventional outpatient session. Financial assessment revealed significant savings with the teledermatology service (based on last years figures £45 saving due to use of teledermatology) 6. ?Efficient use of resource

16. USC referral conversion poor – 8% scc/mm 6450 lesion refs/year  Traditional 6450/15 = 430 opd clinics  Telederm 6450/30 = 215 telederm clinics + 180 opd clinics (28% at 10/clinic)  Much more manageable and flexible

17. In Summary 1. GPs are using ‘ instead of’ rather than ‘as well as’ 2. GP and Patient satisfaction high 3. Efficient use of resource 4. Flexible/sustainable 5. Dermoscopy gives high level of quality/ diagnostic accuracy 6. Plan to use for all lesion referrals