Teledermatology in Scotland Update C. Morton, Stirling, Scotland

Teledermatology in Scotland 2014 Most TD activity: Highland/Western Isles Lanarkshire Forth Valley

Teledermatology in Scotland - 1 NHS Highland Telereferals several times most days: management advice, teletriage and “full” teledermatology (approx cases/wk), & look after the Falklands mainly by telederm (approx 20 pts / yr) NHS Lanarkshire Photo-triage of skin lesions to prioritise +/- onward referral ~3600 patients pa NHS Forth Valley Community-based phototriage – 2 GP surgeries – 1500 pa. Audit: only 20% patients require clinic visit – reminder: direct surgery, nurse led clinic, PDT, or onward referral.

Teledermatology in Scotland - 1 NHS Fife Encourage GPs to attach a photograph with referrals. (not for suspicion of cancer) NHS Borders Electronic vetting for a couple of years and GPs can attach photographs GPs can also for advice – more useful for management advice. NHS Tayside 17% of all referrals arrive with image (all GPs given cameras several years ago Permits triage or management decisions NHS Grampian Teledermoscopy clinic between Elgin and Aberdeen – 100 patients pa. NHS GG and Clyde N.Argyll – GPs have cameras – encouraged to use with picture. NHS Lothian, NHS Ayrshire & Arran - Nil

TD in Scotland – why limited? Different structure to healthcare – Health Boards oversee Primary & Secondary care – no commissioning process Suspicion of management seeing TD as cheap fix to capacity issues, rather than as part of an integrated service 2010 SDS position statement on Teledermatology: cautionary Absence of initiatives to drive forward TD Poor experience of teleconference facilities used in MDTs Research – telephone triage by GPs The Lancet, 4 August 2014 doi: /S (14)

Telephone triage for management of same-day consultation requests in general practice: a cluster- randomised controlled trial and cost-consequence analysis Evaluate two forms of triage (by GPs, or by Nurses supported by decision support software) and compare them with ‘usual care’. 42 practices randomly allocated to provide one of these three access options for four weeks, following a period of training and ‘run-in’ >20,000 patients requesting a ‘same-day’ appointment enrolled. Followed up through questionnaires and notes review over 28 days. Patients who receive a telephone call back from a doctor or a nurse are more likely to require further support or advice when compared to patients who see a doctor in person under the usual care arrangement. Conclusion: ‘telephone triage’ systems do not reduce overall practice workload. The costs to the NHS over 28 days were almost identical, so there was no added cost-efficiency.

New models of care for return appointments (Quality & Efficiency Support Team) Clinicians collaborating to use peer review in three specialties (Derm, Ophth, Gastro) and across NHS FV, Tayside, GG & Clyde New patient centred follow-up models Primary Drivers for this are: People attend traditional OP clinics as last resort Clinic resources are fully utilised More people are assessed at home or in community Current status: completion of audit and patient Qs.