P37 An island story: a successful new model of specialist dermatology provision to a rural area

Abstract

The authors’ health board was invited to take over the dermatology provision of an island health board in 2018. At the point of takeover, the waiting list for new appointments was approximately 33 months. There was a significant burden of return patients, which would take approximately 6 years to process in the previous system. We approached this challenge by implementing several novel strategies. Our own department has an established practice of enhanced vetting of referrals. Essential to this are solid relationships with primary care colleagues to encourage the use of high-quality images within referrals. Referrals are viewed by the vetting dermatology consultant within 48 h. Options following vetting include reassurance regarding benign lesions, or direct treatment advice to the referrer without requiring a clinic appointment. Between August 2018 and December 2022, we were able to deal with 40% of referrals in this way. Other vetting outcomes include direct referral to the local island general surgeons for appropriate lesion removal with advice on excision margins/depth. Pathology results are returned to the dermatologist for interpretation and ongoing care. Vetting consultants can directly book a twice-monthly dermatology video clinic (general or specialist, e.g. paediatric dermatology). Remote monitoring of systemic therapies is undertaken. Dermatology advice is provided for inpatients at the island district general hospital. Suitable patients can be directly booked to see our on-island general practitioner (GP) with a specialist interest in dermatology (GPwSI). We provide quarterly physical visits, consisting of 2 days of consultant-led clinics and complex skin surgery. Our GPwSI colleague is supported by the mainland dermatology team, seeing suitable patients between dermatology visits. They have set up a novel phototherapy service on the islands with support and guidance from the dermatology team. Prior to this, patients needing phototherapy were required to travel to the mainland, often needing prolonged inpatient hospital stays with a significant impact on their jobs, home lives and financial consequences/capacity on the National Health Service. This rural dermatology service is highly effective through the use of enhanced vetting, a well-trained and supported local GPwSI, collaboration with local GPs and general surgeons and remote consulting. The model provides a comprehensive rural service, meaning patients no longer have to travel off island to access general and specialist dermatological services. Using this new model and through dedicated teamworking, there is currently no waiting list for island dermatology patients. Feedback from GPs and patients has been extremely positive.