Teledermatology Pilot in B&NES, Wilts, and Somerset CCGs
This teledermatology pilot program involves B&NES, Wilts, and Somerset CCGs at RUH led by Andy Jennings, Senior Commissioning Manager. The process includes utilizing a Leeds model approach with equipment like iPods, dermatoscopes, and Consultant Connect for streamlined referrals. Outcomes show successful management of referrals with notable reductions in wait times and patient discharges. Challenges include Consultant time wastage and image quality issues that need resolution for smoother operations.
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Teledermatology Pilot B&NES, Wilts and Somerset CCGs at RUH Andy Jennings, Senior Commissioning Manager, Wilts CCG / BSW STP
Practices Volunteers . Near/far, large/small B&NES x 4 (different 4 for each different model) Wilts x 4 (same 4 throughout) (Somerset x 2)
Process (1) Based on Leeds model THANK YOU! All potential 2ww Ipod, dermatoscope (Schuco DermLite DL200 Hybrid), connection kit, Consultant Connect, eRS One set of kit per ~6,000 on list Minimum three images (area, close-up, dermatoscope) Consultant Connect to receive/transfer images to Practice system and eRS referral Add images to 2ww referral Send via eRS
Process (2) RUH receive and review from eRS Book those truly 2ww Respond to GP for those not 2ww for GP management Downgrade those needing to be seen by consultant as routine/urgent but not 2ww Responses copied to patient
Outcomes Descriptor Total 2ww telederm referrals received Confirmed as 2 week waits Downgraded to urgent see within 4 weeks : Discharges First 3 months First 6 months 157 79 = 50% 37 = 24% 41 = 26% 321 150 = 47% 81 = 25% 90 = 28% Percentage of patients who needed an appointment Percentage of these, who needed 2ww 74% 68% 72% 65% Patients who could go straight to ENT/OMFS Patients who could go straight to Plastics 8 = 5% 15 = 5% 1 = 0.3% 0 Time taken per patient average 8.2 mins 7.3 mins
Issues (1) A lot of Consultant time wasted, carrying out supporting admin process, e.g. to save across images from eRS onto hospital PAS system Double data-entry Increased risk of error due to clunkiness between eRS and PAS Scope for confusion for GPs and patients 2ww booking created, but then cancelled/amended At pilot stage, no job-planned time allocated essential for wider roll-out
Issues (2) Image quality resolution/orientation/pressure/etc No images / poor images = remains 2ww Need to implement templated response letters
Timescale Initial discussions Dec 2018 Go-live - Apr 19 Review points Aug 19, Oct 19 Revision to different model Nov 19 Future review points - monthly Planned end date Mar 20 Wider roll-out Apr 20 onwards (subject to timelines for job planning changes)
Next Steps Revised pilot model process about to be introduced: All potential 2ww send via Consultant Connect As Advice & Guidance Response to GP within 2 working days (aiming for same day) Refer, or guidance for management in primary care Priority, to refer GP then raise as 2ww or routine or urgent RUH confident of being able to see all subsequent 2ww in [14 days minus the time spent on the A&G process] direct listing to ENT/OMFS becomes part of OP block funding arrangements From Apr 2020: (1) wider roll-out (2) 28 Day FDS
