Northern Care Alliance
NHS foundation trust
Text with Dynamic Background
ACCELERATING REFERRAL
TO DIAGNOSIS TIME FOR
SUSPICIOUS SKIN LESIONS

Transforming the skin cancer pathway at NCA

The Northern Care Alliance NHS Foundation Trust (NCA) partnered with Open Medical to enhance their skin cancer care pathway. The NCA was dealing with challenges like rising demand and limited resources, leading to delays in treatment. By collaborating with Open Medical, they introduced a teledermatology pathway that reduced the time from referral to diagnosis and improved compliance with diagnostic standards. This new approach not only saved costs but also decreased the need for diagnostic biopsies. But Open Medical and NCA were not the only ones involved in this project; the Patient and Public Involvement Committee at Open Medical also played an important role in shaping the final pathway design, ensuring that it also met the needs of patients.

Challenges

  • The skin cancer care pathway was under significant pressure due to increasing demand, putting strain on the system

  • Nearly 900 patients had to wait over the nationally mandated 62 days to receive treatment

Solution

  • The NCA acquired Open Medical as its key digital partner

  • Together, we redesigned and optimised NCA’s service delivery with a new, more efficient teledermatology pathway by leveraging our cloud-based platform, Pathpoint eDerma

  • The Community Diagnostic Centre (CDC) model was chosen as the conduit for this digital transformation

  • This model made use of remote teledermatology, where a specialist examined patients’ skin lesions following image capture in community setting, coupled with a detailed patient questionnaire, allowing for a swift, thorough, and efficient diagnostic process

  • Conventional face-to-face consultations proved to be resource-intensive, contributing to the inability to meet national standard targets

  • The high expenses associated with face-to-face consultations put pressure on available resources

Key improvements

The referral to diagnosis time was successfully reduced.

Patients received their diagnoses an average of 6.4 days faster

79% of patients assessed via eDerma received a clinical diagnosis or treatment plan within 28 days, a marked improvement from 49.8% prior to the new pathway

Most patients received their diagnosis 14 days sooner

eDerma helped NCA improve their compliance with the faster diagnostic standard of 28 days to diagnosis

NCA and Open Medical gathered feedback from patients on their experience with the new pathway through PREM questionnaires.

Patients from most advantaged and least advantaged Index of Multiple Deprivation Deciles provided similar feedback, indicating a consistent positive patient experience across groups

88.9% of patients agreed, or strongly agreed, that the teledermatology questionnaire was easy to complete

Health Enterprise East (HEE) conducted a health economics assessment. The savings were calculated after factoring in all costs, including the cost of eDerma itself.

The average cost of diagnosing a skin lesion using eDerma was £45 lower per patient compared to the traditional pathway.

It was estimated that using eDerma could save £18,261 in six months compared to the previous pathway

With the new care model, patients were 18% less likely to be referred for a diagnostic biopsy and instead diagnosed directly by dermoscopy assessment or booked straight to treatment. For these patients, cost savings could reach up to £135

Patient and Public Involvement

Open Medical’s Patient and Public Involvement (PPI) committee was actively involved in the project.

90% of their feedback was incorporated in the final pathway design

Helped co-create patient facing materials, including the patient questionnaire

Patients helped guide the analytics, informing further evidence generation

Open Medical colleagues were well engaged in the project working groups to support mobilisation of the pathway within a tight timeframe, delivered training to clinical, operational and administrative teams, and were on-site to provide support during go-live. The impact has been significant, saving two weeks on the time to the first appointment and improving our performance against the Faster Diagnosis from 49.8% prior to implementation to sustained delivery of the standard since December 2023.

Rachel Pearson

Head of Cancer Services Development at the Northern Care Alliance NHS Foundation Trust

In recognition of these achievements, NCA was shortlisted for the HSJ Digital Awards in the category of Optimising Clinical Pathways Through Digital