Dermatology teamBMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i1433 (Published 15 March 2016) Cite this as: BMJ 2016;352:i1433
- Nigel Hawkes, freelance journalist
- London, UK
Beacon Dermatology Service
Helen Frow, a general practitioner with a special interest in dermatology, works in a large practice in Plympton, Devon. Skin problems represent up to a quarter of all consultations in general practice, and the Beacon Medical Group, with 33 000 patients registered, was a major source of referrals to local hospitals, running at 40-50 a month.
“We were acutely aware of the strain on the system with long referral to treatment times,” she says. “So we decided as a practice to take more control of the issue.”
The key to the system is to use photographs, taken with the patient’s consent, which other GPs send to Frow as part of the electronic patient record. Frow then reviews the records and photographs once a week, though patients deemed to need urgent referral under the two week cancer wait are excluded from the system.
“For some I will just give advice to the GP; for others I’ll give interim advice and arrange to see the patient myself. If a patient needs a hospital referral that will be fed back to the GP. We have close liaison with secondary care services, which means we can put patients straight onto operating lists without them needing to see the hospital consultant first.”
The result has been to cut referral rates by 80%, to 8-12 a month. If in-house clinical review is needed, patients are seen in four to six weeks, compared with the 12-16 week wait for secondary care. “Two week referrals have also fallen,” she says. “A lot of our GPs would have sent patients just to be sure, if they had doubts. Since they know I’m looking at …