COVID-19: Dermatology Service Guide (Devon)

Dermatology service update - July 2020

Amicus Dermatology

Reinstating the Dermatology GPwSI Services offered by Amicus Health.

Continue with the use of telephone and video consultation for all patient interactions which do not require either a physical examination or surgical intervention.

COVID symptoms will be checked before the appointment and on the day before entry

Persons will be asked to wait in their car and contacted by the clinician at an allotted time before being escorted into the building via the designated entrance, reducing contact with others and the need to use the waiting room.

The theatre, consultation room and sluice used by the surgical service are physically separated from the rest of the practice. Patients will be able to enter through a separate door and will not encounter any potential Covid patients.

Full PPE will be worn by all clinicians

All no essential items have been removed from the rooms to support quicker and easier cleaning between patients

Scope

This information provides guidance on the management of dermatology patients across Devon during the Covid-19 pandemic. The information is based on national guidance from the British Association of Dermatologists, which includes regularly updated resources for patients and health care professionals.

National guidance

BAD guidance for healthcare professionals

Two Week Wait referrals

Only patients with suspected melanoma and squamous cell carcinoma (SCC) should be referred via the two week wait.

Please include digital photographs with referrals if possible to streamline triage (localising image, close up image, +/- dermoscopic image). Patient images are acceptable.

The Consultant Connect ® smartphone app can be used on personal devices to take images securely and transfer to clinical systems and e-RS referrals.

Photography resources:

RCGP dermatology toolkit including top tips on taking dermatology photos

British Association of Dermatologists Teledermatology Resources

GP Guidance: Using the Consultant Connect App to take secure clinical images using your smartphone

e-Referral Service Selection:

  • Specialty: 2WW
  • Clinic type: 2WW Skin
  • Service:Two Week Wait Dermatology Heavitree-RDE-RH8 / Two Week Wait Dermatology Tiverton-RDE-RH8 / 2WW Dermatology - NDHCT - Litchdon M/C - RBZ / 2WW Plastic Surgery - NDHCT - NDDH - RBZ / DRSS-Western-2WW Skin- Devon CCG-15N / 2WW-Dermatology-TSDFT-Torbay-RA9

Conditions with specific guidance

Basal Cell Carcinoma

Patients with basal cell carcinomas should be managed as routine referrals and treatment will not be carried out during the COVID-19 pandemic.

Only patients with highly symptomatic or rapidly growing lesions where there is diagnostic doubt should be referred through the 2WW pathway.

Routine referrals

All new routine referrals will be clinically triaged and will either be added to a waiting list or, if appropriate, A&G will be given.

Please ensure that a practice-based system is in place to check daily for returning referrals with A&G.

Prior to making a routine referral, please ensure that any appropriate Policy or CRG has been reviewed and that all the suggested investigations and management options have been considered.

Existing new and follow-up routine appointments have been cancelled and changed to telephone / video consultation where appropriate.

Urgent advice

Please call the on-call dermatologist. Urgent dermatology referrals include severe widespread drug reactions, suspected toxic epidermal necrolysis, widespread blistering skin conditions, severe or unstable eczema or psoriasis and erythroderma.

Risk factors for face-to-face review will be decided on case by case basis.

Central nhs.net email addresses or individual nhs.net mail will be used for photographic image transfer between healthcare professionals on an individual case basis.

The Litchdon dermatology e-mail D-CCG.Dermatology@nhs.net can be used as an alternative to telephone to discuss urgent North Devon patients.

Mobile messaging may be used to communicate, including commercial applications where there is no practical alternative, or when there is a need to share information quickly (see NHSX advice)

NHSX COVID-19 Information Governance Advice

Advice & Guidance/Teledermatology services

Advice and Guidance / teledermatology services aim to maintain operation for non-2WW patients

Royal Devon and Exeter Hospital:

Advice and Guidance teledermatology through NHS e-Referral Service (e-RS)

See Exeter Dermatology Information for GPs for information and consent form

e-Referral Service Selection:

  • Request Type: Referral
  • Specialty: Dermatology
  • Service: Tele-Dermatology - for Advice & Guidance only - RDE-RH8
Derriford Hospital – Plymouth:

Advice and Guidance teledermatology through NHS e-Referral Service (e-RS)

e-Referral Service Selection:

  • Request Type: Advice
  • Specialty: Dermatology
  • Service: Tele-Dermatology(Advice and Guidance)-Rowans House-RK9
Torbay Dermatology:

Please use Exeter A&G service

Litchdon Dermatology - Barnstaple

D-CCG.Dermatology@nhs.net

Please send from a secure email (such as NHS mail)

See Litchdon Information for GPs for information and consent form

Clinician user guidance: NHS e-RS Advice and Guidance Toolkit

High risk

Patients will be contacted by their dermatology team with advice on shielding and social distancing, based on a national risk stratification grid of medication and comorbidities. The grid and patient letter are available at:

Dermatology Advice Regarding Self-Isolation and Immunosuppressed Patients: Adults, Paediatrics and Young People

Devon Dermatology contact information

Royal Devon and Exeter Dermatology Department

Tel: 01392 405510 On-call Dermatologist – via hospital switchboard 01392 411611

Plymouth University Hospital Dermatology Department

Tel: 01752 439712 On-call Dermatologist – via hospital switchboard 01752 202082

Torbay Hospital Dermatology Department

Tel: 01803 654837 / 654869

On-call Dermatologist – via hospital switchboard 01803 614567

North Devon Litchdon Dermatology Department

Tel: 01271 312850

Pathway Group:

This guideline has been developed by Devon Dermatology Group and signed off on behalf of the NHS Devon Clinical Commissioning Group

First published: April 2020

Last updated: 17-07-2020

 

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