BT10 Introduction of a medical photography clinic as part of a community diagnostic centre pathway

Abstract The quality of photographs sent in via Advice and Guidance (A&G) requests from primary care for skin lesions can be variable. A pilot study has suggested that up to 50% of patients referred for suspected skin cancers could have been redirected if teledermatology was used before the referral [Bataille V, Hargest E, Brown V, Blackwell B. A teledermatology pilot study in Hertfordshire: triage of 2-week-wait referrals. Br J Dermatol 2011; 165 (Suppl. 1): 137]. Good-quality digital images of skin lesions along with dermoscopic images can be used to prioritize access to skin cancer services and improve the delivery of definitive care at first visits. The national community diagnostic centre (CDC) programme is now in its 4th year. CDCs deliver additional, digitally connected, diagnostic capacity in England, providing patients with diagnostic tests in the community and in as few visits as possible, enabling an accurate and fast diagnosis on a range of clinical pathways. A medical photography teledermatology clinic was introduced as part of a service offered within a CDC with the aim of providing faster diagnoses and avoiding unnecessary face-to-face clinic appointments for lesions referred through a standard pathway (not through the Urgent Suspected Cancer pathway). In this new CDC pathway, if photographs provided with the A&G request are of insufficient quality to make a diagnosis, then patients are booked from A&G direct to medical photography at the CDC. Medical photography have guidelines on macroscopic and dermoscopic images required. Patients are sent appointment letters explaining the process. The images and referral letter are then reviewed in a virtual clinic list. In the pilot phase, we conducted 26 clinics over a 6-month period. On average, 12 patients were booked on to each clinic. Overall, 250 patients were seen in these clinics. Around one-half (48%, 120 of 250) were reassured by letter with appropriate information on diagnosis and management and were discharged, thus avoiding unnecessary clinic visits. The time it took to manage these patients via this pathway was 720 minutes (120 × average 6 minutes per patient). The time it would have taken for these patients to be seen face-to-face was 2400 minutes (120 × 20-minutes appointments), thus saving 1680 minutes or 84 clinic appointments. This pathway has reduced face-to-face clinic visits for patients and increased our capacity for those who do need to be assessed in person, supporting our service recovery. Future work will include a patient satisfaction feedback on the service.