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Sharing images for better dermatology care

Why was the initiative launched?
What is being done?
Is it working?
composition and lighting are the keys
Tips for success
To find out more contact
ImpAct bottom line

Using new technologies to improve links between primary and secondary care in Peterborough

ImpAct bottom line

Why was the initiative launched?

Dermatology is a high volume activity: the fourth highest in terms of outpatient clinic attendance and the fourth commonest reason for patient visits to GPs. These factors suggested that dermatology should be one of the first clinical areas tackled when the Peterborough Hospitals NHS Trust was setting up a major programme of development work. The overriding focus was the quality of care and treatment - rather than a narrow concentration on waiting times. The Trust's Transformation programme was designed to bring a practical whole system approach to service development.

What is being done?

To launch the programme, local managers facilitated a series of discussions between GPs and Dermatologists. These were able to build on strong links between GPs and Consultants that had been established locally since the early days of GP Fundholding. The discussions reviewed the totality of care and identified four specific aspects of the management of dermatology services which required attention. Managers made clear from the outset that the Trust was committed to making any necessary adjustments to the deployment of resources that might by justified clinically. Progress is being made on all four aspects.

  1. First, a new approach to outpatient clinic appointment was introduced with the declared objective of reducing the proportion of patients failing to attend their first appointment - DNAs. As they near the top of the waiting list patients are now contacted by the hospital and invited to suggest a date and time convenient for their first appointment.
  2. Second, a series of discussions were arranged to enable Dermatologists and GPs to agree a local guideline for the treatment of common condition - such as ulcers, eczema and warts. A significant proportion of GPs took an active part in these discussions - a consequence of the good relationships between them and hospital staff.
  3. Third, hospital based specialist nurses and the Dermatologists developed a clinical training programme for practice nurses. Over three linked sessions the course equips them to play an active role in the management of chronic dermatoses in primary care and reduce GP workload.
  4. Finally, and perhaps the most innovatory aspect of the programme has been the development of a system for e-mail referrals from primary to secondary care. Staff in primary care are now using digital cameras to photograph the patients and send digital images of their skin condition to the hospital dermatologists. The system is being piloted in seven practices: the key test is whether diagnoses could be based on electronic images. The images are sent - securely - over the NHS Net. Olympus Cameras sponsored the supply of digital cameras and have provided training in their use.

Is it working?

The programme overall was launched in 1997 and already some benefits are evident. There has been:

The e-mail referral process has been in use in seven practices since October 1998 which already had suitable IT equipment.

One of the early challenges was to help staff in local practices take good images - not the best holiday snaps! It has proven sensible to encourage the individual practices to identify who locally had the best 'eye' for this part of the process. The Trust has since developed a set of tips to support local training. These are:

Remember that composition and lighting are the keys to is the key to better photographs - and:


In the first four months (October 1998 to January 1999), 70 images (relating to 36 patients) were sent to the hospital dermatology department. The early indications were encouraging with over 60% of the images transmitted usable.

Dermatologists were able to use the images to identify the nature of the problems (in 94% of cases) and provide a diagnosis (64%). The quality of the images transmitted is improving with growing experience of the new approach. At this early stages few changes in practice have been identified - but the scheme is proving popular and means of extending the facility to other practices are being explored. It is a practical, cost-effective solution to the challenge of sharing information.

An important by-product of the scheme is the creation of a local library of dermatological images that will be helpful for training purposes - real local patients. Early indications from patients involved in the pilot scheme are very encouraging. Patients are interested in the use of technology and attracted by the possibility of avoiding hospital visits.

The benefits extend beyond dermatology services. The Trust has been able to learn valuable lessons to tackle the information and IT agenda set by the Government paper 'Information for Health'.

Tips for success

To find out more contact

Bill Stephenson
Director of Developments
Peterborough Hospitals
NHS Trust Edith Cavell Hospital
Peterborough PE3 9GZ
Telephone 01733 874954
Fax 01733 331639

The following material is available

Dermatology clinical guideline.

In addition samples of the images can be supplied by email.

The material is also available through the Trust's website on the NHS Net:


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