Roll out of a Tele-dermatology service in Cheshire and Merseyside

In January 2021 as the third Covid lockdown descended on the Liverpool City Region, plans were already in place to launch a proof-of-concept Teledermatology project in a partnership between Liverpool University Hospitals Trust and a small number of GP Practices in South Liverpool.

Led by the Programme Team from Cheshire and Merseyside Elective Care Transformation and Recovery Partnership, the aim was to create a user-friendly way of safely and securely taking digital images of single moles or lesions that are likely to be benign, but do have some signs of being suspicious of cancer. Our research locally together with national data highlighted around 30 per cent of such moles and lesions were being referred unnecessarily under the two-week rule, which has created ever increasing demand to the detriment of other urgent and routine Dermatology conditions.

The aspiration for the model was to design an advice and guidance pathway for single moles and lesions. Through a phone app and the attachment of a Dermatoscope to a smartphone, macro, micro, and dermascopic images can be taken that directly synchronise with the patient’s primary care record system (EMIS web). The images and relevant patients’ details can then be processed and received electronically by the Consultant Team for clinical review, and if necessary, the advice and guidance request to be converted into a referral or returned to primary care to support or advise the patient on self-care.

Funding opportunities became available through NHS Digital to create a two-year programme that has provided: software and licences; programme management; Dermatascopes and equipment.

Our pilot partner IT software provider Cinapsis Smart Referrals were contracted to provide full access to all GP Practices across Liverpool, Cheshire, and Wirral. Through rigorous clinical testing we also purchased Heine Delta One Dermatascopes for all practices in our programme areas, including in St Helens. Four acute trusts – Liverpool, Wirral UTH, Mid-Cheshire and Countess of Chester – have been set up to receive, report, and appoint patients through the pathway.

We formally launched our Liverpool service at an event in March where over 150 GPs and practice staff attended in person and virtually; and at the end of quarter 1 this year, we have 35 per cent of Practices live; and approaching 1,000 cases have been through the system to date.

Initial feedback from users has been positive and Dr Stewart Hale GP and Clinical Lead Brownlow Health @ Kensington Park commented: “I have used Cinapsis about six or seven times now and am impressed with how easy the system is to navigate as well as the quick response times from your team. I like the way the photos save in EMIS as a record and the response times are excellent – I had a response within 10 minutes for one query! The response in the form of an e-letter is great to. “

Through working together with our Cancer Alliance colleagues we secured resources to purchase more Dermatoscopes. This means we can now resource all 373 Practices across the Cheshire and Merseyside area with the hardware required. Our next challenge is to ensure that we can support them with establishing access to an IT platform to enable Teledermatology to establish itself across the whole of the area.