Best efficiency innovation
Wanstead and Woodford Dermatology Service, Redbridge Consortium
• Advice Letter Listing Project – Eastern Federation Pathfinder
• Prospective Review of Referrals – Corby Commissioning
• Wanstead and Woodford Dermatology Service – Redbridge Consortium
Winner - Wanstead and Woodford Dermatology Service, Redbridge Consortium
Redbridge Consortium in London set out to develop a new dermatology system which was cheaper and more efficient. The new system minimises secondary care referrals. Treatment is fast and local patient satisfaction is high.
The consortium commissioned ESS Primary Care Solutions to offer patients
a local GP-led treatment as an alternative to referring patients to hospital. The company provided a package that included a dermatologist, administrative support, and a detailed cost, performance and patient satisfaction analysis.
Patients referred to the service are seen in a weekly clinic at a local health centre by a level 3 dermatology GPSI within four weeks of being referred.
Here they are either treated and discharged, treated and asked to return for follow-up or booked for minor surgery with a level 3 GPSI. If consultant advice is required, they are booked into an education clinic with the GPSI and consultant, following which they are either discharged or referred on for minor surgery or to secondary care.
Clinical inclusion criteria are:
• Basal cell carcinoma
• Lichen plannus
• Acne and rosacea
• Inflammatory skin disorders
• Pigmentary disorders such as vitiligo
• Disorders of hair and nails
• Skin lesions or rash of unknown cause.
Clinical exclusion criteria are:
• Suspected squamous cell carcinoma
• Phototherapy treatment
• Vulval skin disease
• Cosmetic surgery
• Operations that can be treated by the minor surgery DES.
Initially a three-month pilot, the system was so successful that it has been rolled out across 11 more practices and will shortly be running borough-wide.
The pilot was provided at 75% of the local tariff for new patients and follow-up appointments. Minor operations cost £150 compared to the hospital charge of around £500, while basal cell carcinoma excisions cost £350 compared with £500-£3,000. The total cost of the pilot was £6,716 compared with the projected cost of £11,532 under the previous arrangements.
A further comparative cost-saving model – matching the pilot against previous costs – projected a saving of £33,800 in six months.
Over 90% of patients said the service was good or excellent. They said that they felt involved in and confident with the healthcare professional they were seen by.
The pilot had no referrals to secondary care, there were very few prescriptions
(15 items totalling £81.76) and minimal use of cryotherapy. It also had a very low DNA rate (8%). The ratio of new patients to follow-up patients was 1:0.67
Only 18% of patients were referred for
a minor operation and the minor operation clinic had 100% attendance. All patients were given wound-care leaflets after the procedure, and offered follow-up appointments where full histology results were available to the GPSI.
It is hard to fault this innovation. The financial numbers speak for themselves and it's illustrative of what any qualified provider can achieve.
Pritpal Tamber, medical director, Map of Medicine
Good, clear, replicable idea with clear outcomes.
Professor Paul Corrigan, consultant and former Department of Health adviser