Key Messages

Teledermatology in East Devon - Exeter Dermatology Information for GPs

1. Please include skin photos with Advice requests and Referrals

Please attach images wherever possible, except for genital conditions and in patients where there are no visible skin changes.

Photos taken by the GP team or high-quality photos taken by patients (sent to GP through e-Consult or AccurX) can have a very beneficial impact on patient care when attached to e-RS.

2. How to take clinical photos quickly and safely with a personal mobile phone.

NHS Devon has commissioned a secure clinical image app called Consultant Connect PhotoSAF to enable health care professionals to quickly, easily and securely take and transfer patient images into clinical systems using personal mobile phones.

The app ensures the photos can be safely transferred to EMIS or SystmOne +/-nhs.net email and attached to Advice and Referral requests by administrative teams.

The app will resize the skin photographs automatically to a manageable file size for clinical systems. Please follow this link for further information on how to download and use the Consultant Connect app.

Please attach a minimum of 2-3 images:

• a localising image to show the surrounding anatomy and position of the skin condition on the body
• a close-up image to show the morphological features of the rash or skin lesion (hold camera over 15 cm from skin for close-up images)
• a lateral view if the lesion or rash is raised

Dermoscopic images will support the diagnosis of lesions, particularly pigmented lesions and seborrheic keratoses so please include if possible. If you are interested in developing your skills to use dermoscopy, either for diagnosis or to take dermoscopic images to attach to advice or referral requests please contact the Dermatology Consultant team.

Verbal consent is acceptable for direct clinical care. Written consent allows identifiable images to be used for educational purposes. Please consider using the Exeter Teledermatology consent form if you are taking identifiable patient images which could be used for teaching health care professionals in primary or secondary care. Please include a photograph of the signed consent form with the advice / referral request.

3. Use the ‘Advice and Refer Teledermatology’ service for non-2 week wait patients

In line with national guidance, the Exeter Dermatology team recommend that GP teams send all non-2WW Dermatology referrals through the ‘Advice and Refer Teledermatology’ Service (previously known as Advice and Guidance Teledermatology) in preference to the ‘Refer Teledermatology’ Service (which is still available).

The enhanced digital functionality of the ‘Advice and Refer Teledermatology’ service enables the Dermatology team to provide more effective care for patients.

National enhancements to e-RS now allow GPs to authorise the Consultant team to convert an Advice and Guidance requests directly to a referral (please ensure that the box giving this authority is ticked on the referral), supporting shared decision making between primary and secondary care teams.

All A&R requests will be triaged within 2-5 working days, and either returned with advice, converted to a referral into the Dermatology department (urgent, routine or 2WW upgrade) or redirected to community skin lesion clinics as appropriate.

Advice and Referral is recommended at the point that an outpatient referral would be considered, and usually involves direct GP and Consultant communication. If the requesting health care professional is not a GP (e.g., Advanced Nurse Practitioners) it is important that A&R is used in line with GP referral criteria.

Scope

Teledermatology Advice and Refer:

Inclusions - all non-2WW referrals, including:

• Rashes and skin lesions in adults and children
• Basal cell carcinoma
• Bowens disease or precancerous skin lesions not responding to topical 5-Fluorouracil therapy
• Possible skin cancer when it is unclear if a 2WW referral is indicated (please include dermoscopic images with pigmented lesions where possible )

Exclusions :

• Benign skin lesions - unless recurrent (2 or more documented episodes) or persistent infection of a lesion which has required treatment with systemic antibiotics, or other criteria as documented in the Benign Skin and Subcutaneous Lesions Commissioning Policy
• Patients already known to the dermatology service and under clinical follow up – please contact the named clinician’s secretary or email rde-tr.dermsec@nhs.net
• Patients requiring urgent/same day assessment require discussion with the Dermatology on-call Registrar e.g., severe blistering, erythroderma, severe drug reaction, eczema herpeticum. Please call the hospital switchboard 01392 411611 and ask to page the dermatology on-call registrar (Mon-Fri 9am – 5pm). If the patient requires emergency admission to hospital, please arrange this via the on call medical Registrar.

4. Where possible use the 2WW pathway only for suspected melanoma and squamous cell carcinoma

The 2-week wait pathway should be used where a patient clearly meets the criteria for suspicion of melanoma or squamous cell carcinoma⁴

Only consider a 2WW referral for patients with basal cell carcinoma if there is particular concern that a delay may have a significant impact, because of factors such as lesion site or size.

Where it is unclear whether the 2WW pathway is indicated please use the ‘Advice and Refer Teledermatology’ Service with images, as requests are reviewed within 2-5 working days, allowing Consultants to upgrade an A&G request to a 2 week wait referral if indicated.