Streamlining referrals and diagnosis

This part of the DES focuses on the optimal use of diagnostic tests and referral pathways to streamline early diagnosis. It includes appropriate use of:

• FIT symptomatic (👉 improving referral quality )
• Teledermatology (digital dermatology).
• Non-specific symptom pathways.
• Direct access tests.

PCNs should support constituent practices to reflect on and, where appropriate, audit their use of diagnostic tests and pathways to identify where challenges and improvements can be made. Activity in these areas has a strong educational and update focus.

Examples of Practice

FIT symptomatic

Covered within 👉 improving referral quality.

Teledermatology quality improvement project

Undertake an audit of USC skin referrals, including a review of image quality. To support this:

• Appoint a PCN lead to coordinate the project.
• Ensure that non-clinical champion.each practice has a clinical champion and
• Suggest a review of 20 USC skin referrals in each practice within the PCN, considering the following:
  • Does the referral contain digital images (three appropriate images or appropriate reason why missing)?
  • Check image quality for acceptability i.e. images in focus, correct views.
  • Is there appropriate narrative describing the history of the lesion?
  • 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 urgent suspected cancer referral 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 a cancer care review process instigated appropriately?

Review processes for digital dermatoscope equipment

Undertake a practice survey to assess knowledge, competence and training needs. Does everyone know what they should be doing and how to do it? Consider specific practice level training:

• Using the specific type of local equipment.
• Using the local systems for transfer of images e.g. accurx or email etc.
• Using local safety netting and read coding policies.
• How do new clinicians, trainees and locums know how to do this?
• Identify practice systems or specific practice issues e.g. wifi or mobile signal, access to dermatoscope etc.
• Consider systems and protocols that reduce delays in accessing kit and support the kit being in working order.
• Following the survey GP practices across the PCN should meet to review, share learning, practice and create an improvement plan for practices to implement.

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

Digital dermatology training and protocols

For a comprehensive overview of available training and operational protocols see our 👉 dermatology pathway page.

Non-specific symptoms pathway

Please go to the Faster Diagnosis Standard Section of the Website and then Urgent Suspected Cancer Pages for further information.

For further information see 👉 faster diagnostic framework (including non-specific symptoms) and 👉 urgent suspected cancer referrals.

Training Resource

👉 GatewayC – non specific symptoms

 Pathway changes and updates

At a regional level we would recommend that PCNs encourage and support practices to convene update and review sessions on the newer and updated pathways. For instance:

👉 Unscheduled bleeding on HRT

👉 Breast Pain Pathway