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GPs buried under trusts' workload dump

GPs required to take pictures of lesions before skin cancer referrals

Exclusive GPs will be required to submit photographs with any referrals for skin cancer, which will determine whether the patient is seen by specialists, under plans from CCGs in the North East of England.

Under the new system, GPs will have to take three photographs using their mobile phones and a dermatoscope and submit those with the referral. A consultant will then review these and offer either an urgent or routine appointment, or an alternative treatment plan

The CCGs leading the project - NHS North Durham CCG; NHS Durham Dales, NHS Easington and Sedgefield CCG; and Darlington NHS Foundation Trust - said the move is a response to receiving about 150 referrals for urgent dermatology outpatient appointments every week, most of whom do not have cancer.

Pulse understands that NHS South Tyneside CCG is also considering implementing the scheme.

The plans, the CCGs said, will help determine how quickly patients need to be seen and enable other patients to get earlier appointments if they need to see a consultant quickly. They will also fund the dermatoscope and training for the GPs.

Although the plans are intended to remove unnecessary appointments, GPs can request appointments for their patients even if a consultant initially thinks it is not necessary.

Pulse understands that several South Tyneside GPs have expressed concerns to them that the new scheme, intended to save OPD appointments and potentially money for the CCG, will lengthen GP appointments and expose GPs to risk if and when dermatology decline to see these patients. They add that no funding has been offered to compensate for the likely increase in workload, and that the issue has been raised with the LMC.

Another GP told Pulse: ‘I find it hugely disappointing that at a time when it is widely recognised that primary care is under unprecedented levels of pressure, our CCG has decided to further increase our workload with this additional step before an urgent skin cancer referral can be made. We have an excellent local teledermatology service to assess less suspicious skin lesions so I’m struggling to see why this new step is required.

’As well as adding to the workload of already overstretched GPs, I have concerns that it may potentially delay skin cancer diagnoses by making the referral process unnecessarily bureaucratic. For instance, we have been told that if a photo is not uploaded within 24 hours of a referral having been made then it may well be rejected.’

However, Dr George Rae, chief executive of Newcastle and North Tyneside LMC, said he was broadly supportive of these plans - as long as they are implemented correctly: “There might be technical problems with it. Having said that, if the technology is right, if the photograph is absolutely succinct and able to see definitively what the actual lesion is, this is not at all a bad idea.

’It will expedite things. It will make it such that patients will get quicker reassurance of the way forward.”

He said that in his personal experience, he has found that mobile phone images have not been clear enough for definite conclusions, but that the addition of the dermatoscope could be beneficial. He was also optimistic that, with training, the plans should not have an “inordinate” impact on GPs’ workload.

A spokesperson for the CCGs said: ’Digital technology is used increasingly across the NHS and evidence indicates it improves patient experience. This particular technology is already being used successfully in other trusts.

’We have training and other support in place to help with the initial implementation and will be monitoring the programme. Our priority is to ensure patients receive the care they need in the most appropriate place and as soon as possible.’

 

Readers' comments (26)

  • NICE guidance is that we should aim for 3% Positive Predictive Value for cancer referrals. So you’ll have to forgive me if 97% of my referrals turn out not to have cancer.

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  • All these patients are going to need to be seen so it will mean GPs doing more work, with no reduction in the work of the specialists. Obviously all BCC's need to be seen and assessed as 2WW as some of them are SCCs.
    Waiting lists do not reduce work - they increase it ! as this stupidity demonstrates.

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  • Such a shame GP have to refer and not deal with these lesions as GPs do in Australia where I have worked. There was a study eons ago from Liverpool that suggested GPs were better at it anyway (better margins). But it is the description and history that counts. If photo needed use dermascope, if you have that kit might as well do all in house.

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  • GPs are capable of doing these procedures, but not quite so easy on the face without extra training. It is important not to damage nerves & to leave good acceptable scars. There is not enough training set up for this in most of the country. There is also politics. Many dermatologists & plastic surgeons would be resistant to GPs doing this kind of surgery.

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  • Dear Colleague,

    I think this lesion could be sinister according to years of training, experience and gut feeling.

    Kind Regards

    Dr No Time To Waste on BS

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  • Paul C exactly,
    I do Derm 2 days a week and see lots of 2ww referrals. I know the GP's who have already given me the correct diagnosis in the referral before I even look and those I wouldn't trust not to end up setting fire to themselves with the dermatoscope

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