QI: Digital Dermatology

Cancer Referral Quality Improvement: Digital Dermatology example

This will be coordinated by PCN but likely PCN GP practices will have different issues.

• Appoint PCN lead for the project to coordinate
• Ensure that each practice has a Clinical Champion and Non-Clinical champion.
• Suggest review 20 to 30, Fast Track Suspected Cancer referrals skin referrals in each practice within the PCN.

On review of the referrals, could consider:

• Does referral contain Digital Images (Three appropriate images OR appropriate reason why missing)
• Check Image Quality for acceptability – ie Images in Focus, Correct views.
• Is there appropriate narrative describing the history of the lesion (CLINICAL REVIEW)
• Record Staff Role of Referrer to help identify any training needs within staff groups (i.e. GP / GP trainee / F2 / Clinical Practitioner Role (Non Medical).
• Did the patient have the Fast Track Suspected Cancer referrals Patient information leaflet (READ CODE)
• Was any referral safety netting in place (READ CODE)
• Was the referral accepted
• Was there a Skin Cancer Diagnosis outcome
• Was Cancer Care review process instigated appropriately

Could then look at individual practices processes for Digital Dermatoscope equipment:

• Practice survey to assess knowledge, competence and training needs.
  • Does everyone know what they should be doing and how to do it?
• Practice systems or specific practice issues.
  • e.g. Wifi or Mobile Signal, access to dermatoscope etc
• Then GP practices meet to review, generate themes and create an improvement plan for practices to implement.This maybe shared best practice from other GP practices within the PCN that are doing well. This could include:
  • Clinician training on Fast Track Suspected Cancer referrals & equipment
    • NCA Skin Lesion Training Session recommended for all Cancer Skin Referrers:
    • NCA Educational Dermatology Webinar:
    • Differentiating Benign from Malignant Skin Lesions in Primary Care. 
    • Click to DOWNLOAD PRESENTATION SLIDES
    • Specific practice level training
      • Using the specific type of local equipment
      • Using the local systems for transfer of images eg accurx or email etc
      • Using local safety netting and readcoding policies
      • How do new clinicians, trainees & Locums know how to do this?
    • Gateway C – Skin Cancer Module: https://www.gatewayc.org.uk/courses/skin-cancer-early-diagnosis/
    • Dermoscopy features video: https://egplearning.co.uk/introduction-to-dermoscopy-for-gps/
  • Improve Readcode adoption for Fast Track Suspected Cancer Referrals Patient leaflets – use of templates etc
  • Improve Safety net processes – Consideration of use of Cancer Care Coordinator role?
  • Improved Equipment process (Dermatoscope and iPhone) e.g.
    • Sign in / out register for Dermatoscope
    • Administrator guardian of the Equipment
    • Administrator Equipment “runner” to bring the equipment to the Clinician.
    • Arrangements for Images to be taken by other staff / other clinics
    • Case/Box to protect Equipment
    • Equipment charging check list
    • Portable battery to ensure that charge throughout the day.

Then Re-audit after 6 months to assess impact of changes in all practices.