Improved diagnosis of skin conditions by GPs thanks to transformative education programme

Bury-CCG

GPs in Bury have been provided with education and new equipment to help diagnose skin conditions within the practice, reducing the need to refer as many patients for an urgent specialist dermatology assessment.

Demand on specialist dermatology services is high, however, around a quarter of urgent referrals to dermatology services for lesions where cancer is suspected, result in being for conditions such as benign moles or seborrheic keratosis – a non-cancerous skin lesion.  These conditions could be diagnosed and managed by GPs in primary care, with the right education.

As part of a pilot project, 31 of Bury’s GPs participated in the DECIDE Education ProgrammeTM led by Dr Mini Singh from Manchester University; supported by Health Innovation Manchester and dermatologists at Salford Royal NHS Foundation Trust.

GPs attended a one-day workshop and completed online learning to develop their decision making skills and learn how to use a piece of kit called a dermatoscope.

Dermatoscopes are handheld devices that magnify the skin multiple times and use light to allow them to see colour and structures in the skin that are not visible to the naked eye. This helps the GP to observe and diagnose some skin lesions, preventing a referral to specialist services in many cases.  Where a specialist opinion is needed, the GP can refer the patient to dermatology for an urgent assessment.

The introduction of the new equipment gives many patients a speedier diagnosis and peace of mind without the wait, whilst freeing up specialist services for patients that do need them.

In the first two months of the pilot, which launched in May 2019, over 120 urgent referrals to dermatology services were avoided because local GPs were educated and had the equipment and confidence to make a diagnosis in the practice.

Wendy Craven, Clinical Lead at NHS Bury Clinical Commissioning Group (CCG) said:

“The introduction of the education programme and dermatoscopes into Bury GP practices has been well received by our clinicians, bringing an additional skillset to primary care. Many patients are now diagnosed within the practice and therefore don’t have the worry of waiting two weeks to be seen by a specialist, freeing up dermatology services for patients that do need to be assessed by a skin specialist urgently.

“At the heart of the project is to care for patients in the most appropriate setting, and whilst it is early days, initial figures suggest that it is having a significant positive impact with speedier diagnosis and an overall improved experience for many patients.  It also ensures the most appropriate use of NHS services when they are in demand.”

Craig Marshall, a health worker and Bury patient has benefitted from this new offer, he said:

“I went to see my GP to have some moles checked out.  My GP was confident all but one of the moles was normal, and thanks to her education along with the availability of the dermatoscope, she was able to look at the remaining mole in more detail, which thankfully was also normal.

“Without this new facility, my GP would have had no choice but to have referred me to see a dermatologist, but instead, I was able to get an answer straight away.  Had I been referred I would have likely had a couple of weeks wait to see a skin specialist and this wait would have caused me to worry. Not only was the speed of the process better for me, it also freed up that specialist appointment for someone that really needed it.”

“I was really impressed that as part of my appointment I received information about what to look out for in terms of changes, which I felt put me more in control, and my GP took photographs so that we can compare any changes to my moles over time, which was really reassuring.”

The CCG is planning to roll out this education to all Bury GP practices by February 2020, and will fully evaluate the pilot with the University of Manchester and Health Innovation Manchester after one year.