Lancashire and South Cumbria’s Radical Redesign of Skin Cancer Pathways with Teledermatology

Image created by Rudy Chidiac. © Open Medical 2024. All Rights Reserved

Dermatology services within the Lancashire and South Cumbria Integrated Care Board (ICB) are under immense pressure. Rising demand for care, coupled with a shortage of specialists, has led to prolonged patient wait times and unsustainable workloads for healthcare providers.

The scale of the challenge is clear. “Last year, we had 24,000 skin cancer referrals — and less than 4 per cent of those patients had cancer,” explains Lindsey Buttery, Senior Project Manager for Skin Pathway Improvements at the Lancashire and South Cumbria Cancer Alliance.

“Therefore the vast majority of patients were being seen on a skin cancer pathway unnecessarily. With the increasing demand year on year, there is less capacity to treat those who need urgent care.”

Recognising the inefficiencies, the Cancer Alliance knew it was time for bold action. “We needed to do something fairly radical to ensure patients at higher risk were prioritised for our specialists, but also make sure that all patients’ non-cancer concerns were being met too,” Lindsey says.

And radical they were.

A vision for a more efficient dermatology service

The Cancer Alliance, ICB, and its four connected Trusts envisioned a pathway that would redirect patients who didn’t need to be on the skin cancer pathway to more appropriate services — whether that be their GP, community dermatology, or a routine Trust pathway.

This change would preserve secondary care capacity for patients requiring urgent intervention while ensuring everyone still receives timely, high-quality care. It would also work to eliminate variations in access and care standards across the region. To bring this vision to life, they implemented a new model of care powered by Pathpoint eDerma, Open Medical’s cloud-based teledermatology platform.

Teledermatology in action

The new model of care offers flexibility for patients to access the teledermatology pathway through direct referral from a GP to Trust or from one of the ICB’s primary care skin hubs.

Patients visit their GP with concerns about a skin lesion, and the GP submits an e-RS referral to one of the Trusts. If the patient is suitable for teledermatology, the referral is directed to Pathpoint eDerma via integration with e-RS. From there, the patient is booked for a photography appointment, and a digital patient questionnaire is sent to gather further details.

Patients accessing care through a primary care skin hub follow a similarly streamlined process, although they can be directly sent for a photography appointment without the need to wait to see their GP. If deemed suitable for teledermatology, the skin hub submits an eDerma referral. The patient is then scheduled for a photography clinic, and the same digital questionnaire is issued.

This shift in approach brings care closer to patients. “We’re bringing image capture closer to patients’ homes, and the idea is we’ll have numerous skin hubs across Lancashire and South Cumbria,” explains Lindsey.

Once the patient’s details — including referral images and completed questionnaires — are uploaded to eDerma, they are reviewed remotely by a central virtualised triage team. This team is made up of consultants, cancer nurse specialists, and GPs with a specialist interest in dermatology.

“The central virtualised triage team reviews referral images and questionnaires in order to triage cases, and assigns next steps — all remotely on eDerma,” Lindsey explains. “The next steps are then sent back via integration with the local Trust’s EPR or DMS via eDerma, where patients are referred to the appropriate care pathway — whether that’s discharge back to the GP with advice, redirection to a community health provider, redirection to a Trust routine pathway or to continue on the urgent suspected cancer pathway.”

This means some patients avoid secondary care altogether.  “While some patients will still need secondary care intervention, looking at our current data we estimate that around 90 per cent can be redirected to community services, Trust routine pathways or stay in primary care,” Lindsey adds.

A global model with local benefits

As Lindsey explains, ‘The idea is that the central virtualised triage team could work remotely from anywhere. Of course, they have to meet our standards and go through onboarding, but we’ve had one of our consultant triaging cases while at a conference in Rome, for example.”

With the central virtual triaging team and the new teledermatology model, triaging the large amount of non-cancer cases is removed from clinicians in Trusts, allowing for increased face-to-face consultations and surgery capacity. “This model allows Trusts to take that away and free up our specialists’ clinical capacity to be seeing and treating the patients that need to be seen.”

Lancashire and South Cumbria are already experiencing the benefits of their new model of care. “It is still early days, but around 70 per cent of our patients are being discharged off the cancer pathway and redirected back to their GP or community dermatology for appropriate care and treatment,” says Lindsey.

Teledermatology: Meeting the needs of today

While face-to-face appointments remain the gold standard in healthcare, the current demand calls for a different approach — one that ensures patients can easily access care and receive prompt treatment.

“The dermatology workforce is ever-shrinking whilst demand is ever increasing,” Lindsey concludes. “We need solutions that can bridge this gap, and teledermatology is an excellent tool for it.”

By combining a clear vision with effective technology, Lancashire and South Cumbria Cancer Alliance and ICB have created a forward-thinking care model — one that is transforming dermatology services, elevating patient care, and setting a powerful example for modern healthcare.