North and North East Lincolnshire Dermatology Service Presentation - - PowerPoint PPT Presentation

North and North East Lincolnshire Dermatology Service Presentation

Virgin Care

Virgin Care private and confidential www.virgincare.co.uk

Welcome and introductions

Todays presentation is delivered by: David Pratt – Regional Business Analyst/Project Manager Heather Morris – Senior Operations Manager

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Virgin Care private and confidential www.virgincare.co.uk

We’d like to tell you about

• Who we are
• What the community dermatology Service is commissioned to deliver
• What is changing from April 2017
• Teledermatology
• Patient Involvement

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Virgin Care private and confidential www.virgincare.co.uk

What we do

Virgin Care have been chosen by NHS North Lincolnshire Clinical Commissioning Group (CCG) and NHS North East Lincolnshire CCG as the provider of North and North East Lincolnshire Dermatology services as from 1st April 2017. We have been providing the Community Dermatology Service in North Lincolnshire

• n behalf of NHS North Lincolnshire CCG since 2012, and will be contracted to

provide the Community Dermatology provision in North East Lincolnshire from the 1st April 2017. Our service is delivered in the community closer to home by:

• Consultants
• GP’s with Special Interests in Dermatology
• Nurses
• Minor surgery doctors
• Heath Care Assistants
• Administrators

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What type of conditions we treat

What we do: Teledermatology Skin Cancer The following, where not responding to primary care treatment: Actinic solar keratosis Troublesome acne Moderate/severe psoriasis which may need light therapy. Moderate/severe eczema which may need light or systemic therapy Allergic contact dermatitis or other moderate inflammatory dermatoses Minor surgery Hyperhidrosis not responding to primary care management

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What we don’t do: Patients with suspected low risk BCC - Basal cell carcinomas (BCCs) are slow-growing, locally invasive malignant epidermal skin tumours which are thought to arise from hair follicles. The tumour infiltrates local tissues through the slow irregular growth of subclinical finger-like outgrowths and morbidity results from local tissue invasion and destruction, especially on areas of chronic sun exposure, such as the face, head and neck. These patients will be managed within GPwSI/ Community Skin Cancer Clinician service(NEL) Referrals for lesions with high suspicion of cancer which are on the extended T Zone face should be referred onwards from the dermatology service directly to a maxillofacial surgeon at a local tertiary centre. The criteria for referral will be agreed between the service provider and the tertiary service.

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What type of conditions we don’t treat

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What we will be delivering

• Free NHS Dermatology Services
• Referrals in to the service are made via your GP
• Care closer to home in the community
• For routine appointments, the referral to treatment time will be 4 weeks.
• For Urgent appointments you will be seen within 2 weeks
• Single point of access
• Teledermatology

Am I getting the same level of clinical care as I would have had if I went to the hospital? Yes you are, the Dermatology service is just delivered in the community in order to deliver care closer to home, for those accessing the service. You will still be treated and supported by a fully trained clinical time including Consultants, GPs, Specialist Doctors, Nurses and Health Care Assistants in a health care setting.

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Locations

Stirling Medical Centre, Striling Street, Grimsby , North East Lincolnshire, Lincolnshire, DN31 3AE The Roxton Practice, Pelham Rd, Immingham DN40 1JW Weelsby View Health Centre, Ladysmith Road , Grimsby, Lincolnshire, DN32 9SW Cromwell Road, Grimsby, Grimsby , North East Lincolnshire, DN31 2BH

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Teledermatology

This will mean that for some skin conditions, your GP and our service will work together using high quality digital imagery to allow your GP to oversee your treatment and ongoing care. This will save you time, and ensure you only need make appointments at the dermatology service if these are necessary.

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If your GP thinks you have a dermatological condition and queries whether your condition could be managed in your own GP Practice setting or if you need to attend a more specialist service in the community, they will send a teledermatology referral directly to us. Teledermatology allows specialists quickly to examine and triage cases from photographic images, recommending referrals to the specialist community service or secondary care where appropriate, but

• therwise triaging cases back to the community with a

suitable management plan.

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Virgin Care private and confidential www.virgincare.co.uk

How does Telederm work?

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• 2. Exploring Teledermatology and our technology needs
• 2. Primary Care
• 3. Telederm

Triage Hub

• 4. Appropriate care

setting

• 1. Patient need
• How will the patient

access self help information before appointment?

• How will they know

what to do?

• Good website with self

help information

• Which clinician will take the

pictures?

• How will we market to and

select GP practices?

• Which patients will be eligible

for Telederm?

• Quality camera/ dermatoscope

that is CE marked and meets minimum standards for picture

• quality. £50-300 price range.
• Screens to view pictures in big

enough size

• System for referring clinicians to

register an account and upload images securely

• How many consultants do

we ideally need to review

• ur patient numbers?
• Can we share this

resource nationally?

• System for sharing

information back with referring clinician /

• practice. Clinician will then

copy directly into own patient record system

• GPs ideally emailed by

system to say results available

• How will we ensure people

are seeing the right clinician first time?

• How will we ensure

patients get the letter with the appropriate action?

Key questions Technology requirements Steps

• Patient looks for self-

help information online

• Patient attends GP

appointment

• Patient referred by GP /

nurse for Telederm using VC provided camera and software

• Telederm consultants

review images and send back diagnosis within 48 hours along with any care notes for GP

• Patient sent a letter with

results and either given all clear, given care advise or referred to VC Derm service in person

• r secondary care
• Follow up letter to be

produced and sent to patient advising them of next steps

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Conditions suitable for teledermatology referral Conditions not suitable for teledermatology referral

• Benign skin lesions, for diagnosis, to exclude

possibility of malignancy, or for advice as to whether treatment is available.

• Potentially malignant lesions, includes BCC but
• thers only if low suspicion of malignancy (can

be triaged directly to surgical treatment if necessary)

• Rashes with unknown diagnosis, or to confirm

suspected diagnosis

• Rashes with known or strongly suspected

diagnosis, where management advice is sought

• Significant suspicion of high risk skin cancer

(SCC, melanoma etc). These must be referred

• n the 2 week wait pathway.
• No rash present or minimal, e.g. urticaria,

excoriation due to pruritus.

• Severe rashes with extensive involvement of the

skin, or highly symptomatic e.g. severe eczema

• r psoriasis, likely to require complex

management.

• Children with significant eczema (requires

explanation to and discussion with parents)

• Genital Images

Who will use Telederm?

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Meet John…

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…a 43 year old male living in Oldham. He has always had good health. He has recently found a rash on his arm that is red, itchy and bumpy under the skin..

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“I have started getting a strange rash on my arms…I‟m going to google it.” “I google „bumpy rash on arm‟ and my local Dermatology website comes up. They advise me to book an appointment with my GP because it‟s red and itchy.‟ “I visit my GP who asks me about my medical history and takes a photo of my rash using a digital camera. He told me the Oldham Total Skin service will get back to me‟

John’s care journey

Rashes Acne

“I attend the Skin Clinic and am prescribed a cream for my rash. After the appointment, I can call back to arrange another visit within 6 months if I need to” “I am sent a letter with an appointment to see the Skin Clinic with time and a number to call if I want to rearrange. I also receive a text message reminder 48 hours before”

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Virgin Care private and confidential www.virgincare.co.uk

The GP journey

“ John comes into the GP practice with a rash but I am not sure if it could be something more serious. I take a picture of the rash and upload it into my Teledermatology system. I have told John that the Oldham Total Skin clinic will send him a letter with the outcome.‟ “I get an email from the Teledermatology system the next day and was interested to learn that it could be a rare type of

• eczema. They advised that I refer John to

the Oldham Skin Clinic" “A letter is received at the practice with a summary of John‟s Telederm referral. This is scanned into the record by the admin team at the practice" “A discharge letter is received at the practice with a summary of John‟s Telederm appointment. This is scanned into the record by the admin team at the practice"

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Benefits

• A more convenient NHS dermatology service to help with their skin complaints.
• Provide an innovative approach to dermatology care
• Ensure as many people as possible are treated in a community setting through the

provision of prompt specialist advice and treatment options.

• Prevent avoidable and inappropriate referrals to the dermatology.
• Improve access to dermatology services for patients
• Improve the quality of triage so that patients can see the correct specialist at the

first appointment if a face to face appoint is required.

• Reducing the time taken for patients to access specialist services.
• Facilitate GP education
• Primary care clinicians can quickly and easily obtain a second opinion when

required.

• A specialist diagnosis and management plan for the great majority of patients is

available within 48 hours, faster than would otherwise have been the case.

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Process

GPs will take photos of their patients’ skin issues and send them to the dermatology service through a secure system. A specialist consultant from Virgin Care’s service will then review the referral and make a decision on the best next steps for the patient, getting back to the GP within 3 working days. Virgin Care’s service will then give GPs a treatment plan which the GP can carry out, if treatment with the GP is not possible, the patient will be booked there and then for a face-to-face appointment at the dermatology service, be booked for an onward referral to another specialist, or get booked in for a minor procedure. By launching the teledermatology system the service Virgin Care is ensuring that as many people as possible are assessed and treated closer to home, as in many cases they won’t always need to travel further than their GP practice. The teledermatology will also prevent avoidable referrals that don’t need to go to the dermatology service

• r secondary care, and will mean that patients can see the correct specialist for their

needs at their first appointment.

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What could be the outcome of my teledermatology referral?

• A Treatment plan sent back to your GP with instructions for management in your

GP practice.

• If required, you will be contacted to arrange a Face to face appointment with the

specialist dermatology service.

• If required, arrangements for the onward referral to another specialist; this may

involve your GP offering you a choices of local services

• Direct listing for minor procedure with the specialist community dermatology

service. You will be given adequate preoperative information about skin surgery in written format should this be the best option for you. If you prefer you can opt for a face-to-face discussion with the skin specialist or skin surgeon if you decide you would like to discuss your procedure before this is undertaken.

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We are recruiting

We are always looking at ways to improve our services and value patient feedback. If you have any feedback good or bad please let us know. We are also recruiting to our Patient Participation Group, this group meets quarterly and helps give views on the service, planned improvements and helps us shape our service with the view of our service users, if you would like to join this group, please get in touch.

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Virgin Care private and confidential www.virgincare.co.uk

Website

What would you like to see on our Dermatology Website?

• Online booking?
• Patient information?
• Self help?
• Contact us section?
• How to find us?
• What to expect?

Any other ideas?

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VC Dermatology Website

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Online booking Self-help information Service specific information

Moles

N&NE Lincs

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Virgin Care private and confidential www.virgincare.co.uk

Communication

How can we communicate with you?

• Phone?
• Email?
• Text message?
• Social media?
• Letter?
• Posters?
• Leaflets?

What would you like to see?

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Virgin Care private and confidential www.virgincare.co.uk

Needs assessment – to meet local needs

What other locations would you like to be able to access the Dermatology Service? How did you get here today? Car Taxi Bus Walked Train Bike Other What days would you prefer to visit the service? Monday Tuesday Wednesday Thursday Friday Saturday Sunday Anytime What times would you prefer to visit the service? Morning 9am to 11am Lunch time 11am to 1pm Afternoon 2pm to 5pm Evening 5pm to 8pm I don’t mind

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Do you have any thoughts or suggestions on how we could improve the service?

Virgin Care private and confidential www.virgincare.co.uk

Questions?

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Virgin Care private and confidential www.virgincare.co.uk

Get in touch

If you have any questions or queries please don’t hesitate to contact us: Virgin Care North and North East Lincolnshire Dermatology Service Melton Court Gibson Lane Melton HU14 3HH t: 01482 638 571 e: VCL.NLDermatology@nhs.net

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