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Digitising dermatology in Scotland to drive a future of better care for patients

The use of digital channels to augment and complement traditional patient care pathways has exploded in response to the pandemic and continues to be an important part of the NHS’ recovery. Digital technologies have been a vital tool in maintaining continuity of care for patients, as well as a valuable gateway to the NHS for new patients needing care, across many disease areas and specialties.

Whilst the pandemic has dramatically adversely affected medical care, in some cases, it has provided the opportunity for digital to prove its worth and potential not just in the emergency response setting, but as an integrated element of NHS services going forward.

To make this a reality, the focus has to switch from acute implementation to long-term integration. Taking time to analyse the uptake, performance, acceptance, and value of the digital initiatives rolled out during the pandemic, and applying those insights to ongoing service redesign, will ensure we create robust, integrated care pathways that deliver excellent care for patients, reduce pressure on the workforce and deliver value for the NHS.

Recognising excellence in digital care innovation

Against this backdrop of digital growth, AbbVie had the privilege of sponsoring the Digitising Patient Services Initiative category at the recent Health Service Journal Awards (HSJ) in November 2021.

The annual HSJ Awards are a celebration of excellence and best practice across the NHS, and last year’s awards provided a platform to recognise the commitment, resilience, and innovation we saw from NHS teams during the acute phase of the pandemic.

The pandemic demanded new ways of delivering care and in some cases, existing or planned digital initiatives were evolved and rapidly expanded to meet these emerging needs. The winning entry is a perfect example of the power of digital for delivering patient care and reinforces the value of collaboration for successful and sustainable service redesign.

The Digital Dermatology Assessment (DDA) service is a collaboration between NHS Forth Valley, Greater Glasgow + Clyde and Grampian, Storm ID, Modernising Patient Pathways Programme (Scottish Government), NHS National Services and NHS Education for Scotland, and was designed to provide a viable, efficient and user-friendly alternative to face-to-face care for dermatology patients.

The aim of the service was to ensure that patients could be assessed without the need to visit hospital, at a time convenient to them and to their care team. This would reduce clinic overcrowding, save patient and clinic time and reduce carbon emissions by removing unnecessary journeys.

Colin Morton, Lead Consultant Dermatologist, NHS Forth Valley said; “The trouble with delivering care remotely is that dermatology is a visual specialty, and whilst video-based consultations can play a role in care delivery, video has a number of important limitations. The quality of images and video can hinder visual diagnosis and patient access to and familiarity with video technology can be limited. The challenges we’ve all experienced with this kind of tech during lockdown can also make video consultations more time consuming than the face-to-face equivalent, adding further pressure to clinicians and clinic staff.

“On the flipside, a system where patients submit images to the clinic has its own limitations; clinicians lose important information and context that is important for accurate assessment and diagnosis.

“The ideal middle ground was to develop an asynchronous approach, with patients providing good quality images and accompanying explanatory text for a clinician to review in a set time frame before sending a comprehensive response back,” explains Mr Morton.

Delivering progress through stakeholder and patient collaboration

To succeed however, any new system had to be simple, functional, and accessible, and key to this was collaboration. The team collaborated with an experienced industry partner and from the start the project team engaged with patients to shape service development and ensure that the resulting platform was one patients wanted to use.

The start of the pandemic resulted in an even greater need to deliver care remotely and reinforced the importance and urgency of the project. It also led to evolution and expansion of the initiative from the initial focus on existing patients to encompass new patients. The importance of a service for new patients was clearly demonstrated by the fact that in the end, 70% of DDA activity in 2020/21 was for new patients. Patients who, in the absence of the DDA service, would have experienced delays to care that impacted quality of life, preventable disease progression and would have presented to the NHS in the future with more severe disease that was more costly to treat.

The sustainability of the service over the longer-term was also a key consideration. Its total integration, from appointment generation through to hospital and GP patient records, was a priority for the team and is fundamental to it remaining a core element of dermatology services in the future.

Colin Morton continues; “Overall, more than 3,000 patients have had DDA appointments with over 2,500 of those during 2020/21 and the lengthy periods of lockdown. In addition to the benefits to patients and the local NHS in the two original health boards, the initiative is in the process of being rolled out across NHS Scotland in addition to being adapted for use within other specialties such as pain and gastroenterology.”   

Initiatives like this, that combine improvement in patient care with more efficient services that save time and resources, are fundamental to the successful recovery of a resilient, robust, and more effective NHS. Sharing best practice allows the benefits of such initiatives to be replicated across the NHS, and platforms like the HSJ Awards are key to showcasing examples of excellence and sparking new ideas and thinking.

AbbVie’s Corporate Communications Lead, Cheryl Pitcher, who presented the award to the winning team, commented; “Digital technologies can help reduce the care backlog going forward by freeing up in-person care for patients who need it whilst reducing clinic visits and travel time for those who can be effectively treated remotely, but it has to be tailored to patient needs, accessible and integrated with traditional services.

“We were thrilled to support this winning project and be able to showcase it as a powerful example of how the NHS and industry can work together – and in partnership with patients - to transform NHS services for the better.”

Date of Prep: March 2023