BT16 BT17 Dermatology advice and guidance: a service evaluation

• Published in: British journal of dermatology (1951) 2024-06, Vol.191 (Supplement_1), p.i196-i196
• Main Authors: Sathanantham, Kugili, Hickey, Sian, Ellison, Judith
• Format: Article
• Language: English
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1093/bjd/ljae090.414

We wish to present a service evaluation undertaken of the regional dermatology advice and guidance (A&G) service provided within our locale. As part of the national Elective Care Transformation Programme, A&G services were created, primarily as a consultant dermatologist-led service prior to referral. This was designed to transform the way in which primary care referrals are managed with continued access to specialist clinical advice. The process permits the streamlined conversion to National Health Service referral if required and is being advocated as a potential main referral pathway to dermatology in England. This has resulted in a 400% increase in dermatology A&G requests since the onset of the COVID-19 pandemic in 2020 across England. In real-world practice, this translated to 200 referrals over a 2-week period across four trusts. Our service evaluation analysed the practices across the region to capture the way this service is currently delivered. We focused on the grade of the provider of A&G, whether a rota system was in place, how this was job planned into clinical activity, the service platform utilized and the size of the region the service covered. Each referral was assessed to ascertain the grade of the referrer and whether appropriate imaging and an adequate past medical and medication history were provided. From our service evaluation, approximately 25% of A&G outcomes were directed to have a referral only, 30% of outcomes were advice followed by formal referral if advice did resolve the problem, and 25% of referrals were given advice only. Overall, 20% of referrals were rejected due to either inadequate imaging, inadequate history and imaging, or an inadequate history alone. In conclusion, 70% of the surveyed consultants felt the A&G referrals were subjectively useful to patients and as an educational tool to general practitioner colleagues. This service evaluation provided a baseline understanding of A&G: 25% of current referrals were managed via this service alone, and 30% of the referrals were given a trial of advice with safety-net formal referral advocated if advice did not resolve the issue. As a result, nearly 50% of referrals were managed via an electronic referral service where they would have previously been managed via a face-to-face clinic appointment.