Category: Scheme best illustrating Technological Innovation
Name: Sandra Lawton
Job Title: Nurse Consultant Dermatology
Organisation: Queen’s Medical Centre, University Hospital NHS Trust
Email: sandra.lawton@mail.qmcuh-tr.trent.nhs.uk
Telephone: 0115 924 9924 ext 44737 or 07798821673
Key team: Sandra Lawton - Nurse Consultant, John English - Consultant Dermatologist, Linzi Wildgust and Jo McWilliam - Liaison Sisters, Nottingham City, Broxtowe & Hucknall, Gedling And Rushcliffe PCTs, United Telemedicine Ltd
Title: The development of a district wide dermatology service using teledermatology
Four primary care trusts (PCT) and the dermatology department at Queen’s Medical Centre, Nottingham have developed a district wide nurse-led teledermatology service and general practitioner with a special interest (GpwSI) service in one PCT.
Demand for dermatology services is increasing, which in turn has led to increased waiting times for a dermatology consultation. This concern has been highlighted within the NHS Plan (DOH 2000) as one area where nurses and general practitioners with a special interest (GPwSI) can make a significant impact, reduce waiting lists, deliver modern patient centred services working across traditional boundaries and undertaking a wider range of clinical skills.
Aim:
- Provide effective and efficient diagnosis, treatment and management of dermatological conditions in primary care thus giving patients quicker and easier access to dermatology professional.
Objectives:
- To diagnose, treat and manage patients in a primary care setting instead of having to attend hospital.
- To achieve a reduction in waiting times for patients
- To improve access for patients
- To improve GP satisfaction with the service
- To ensure a consistent approach to dermatology referrals across the district using mutually agreed guidelines.
- To increase the dermatological skills of health professionals by providing advice to all referring GPs and other health professionals on the future management of the patient and the management of similar conditions in other patients.
- To make more efficient use of consultants time
- To manage demand more effectively by reviewing referral patterns
Proposals were put forward by the individual PCTs for a community-based dermatology service based on teledermatology with nurse led and GpwSI clinics. However it was felt that the proposed service should be co-coordinated and integrated across the PCTs to ensure an equitable, accessible service for the population of Nottingham.
Patients who fulfil the referral criteria are seen in the community clinics assessed and provided with a comprehensive management plan. If there is diagnostic doubt or advice is needed regarding treatment plans they are referred to secondary care via teledermatology to the consultant dermatologist. Pathways of care have been incorporated into the project to ensure a smooth appropriate journey for dermatology patients between primary and secondary care services.
Coordination and integration across the district was seen as a crucial element in the success of such a large project. We have been able to ensure a consistent service in each PCT with a specialist dermatology nurse taking responsibility for an individual PCT with referral guidelines, treatment protocols and referral pathways into secondary care utilised district wide. A steering group was established with a multi-professional membership from all the PCTs (Broxtowe & Hucknall, City, Gedling and Rushcliffe PCT) and Queen’s Medical Centre:
- Consultant Dermatologist- Clinical Leadership
- Nurse Consultant Dermatology- Nursing Leadership
- Liaison Sisters
- IT departments
- Project Leads from each PCT
- GP Representation from each PCT
- Patient Access Co-Coordinator Secondary Care
- United Telemedicine Ltd (TeleMarque)
- Audit Department Primary Care – to undertake patient and user satisfaction
The nurse led service commenced in April 2002 and GPwSI in July 2002. Regular meetings of the steering group continue with a further sub group comprising the nurses and project leads from each PCT. This has ensured any concerns or issues have been addressed and solved very quickly. Qualitative data has been collected from questionnaires from patients over a three-month period (December 02 to March 03) and from GP practices who have used the service for their patients. Dr John English, Consultant Dermatologist and Sandra Lawton, Nurse Consultant provide clinical supervision for the nurse led service.
Information technology provided the greatest challenge but with the support of United Telemedicine Ltd the issues have been resolved:
- Make the Telemarque© software ready for our use
- Install the software on laptop personal computers to be used in nurse led clinics
- Install the software in the Dermatology Department in Queen’s Medical Centre
- Test the communication system in conjunction with the Trust’s IT Department
- Train the nurses and consultant in the use of the system
- Provide continuing support
- Provide follow up training and master classes
The opportunity to disseminate our practice locally and nationally with presentations /requests from:
- Variety of practitioners
- CNO Regional Meeting
- Modernisation Agency refers enquires to Nottingham. Huge national interest.
- NatPaCT
- Local and national conferences/ publications
- 2004 –Invited to present at Welsh Assembly Event (Nurse Consultant) and Centre for Change and Innovation, Scotland (Nurse Consultant and Dermatologist)
- Future Plans – continuation of service and project involving the older person.
We have achieved our aims and objectives and an added bonus has been the recognition through awards for the service we have developed:
- Nurse Consultant – Awarded Public Servant of Year 2004 for leading nursing service
- Highly Commended BUPA Awards – Clinical Excellence
- Healthcare IT Effectiveness Awards –short listed, finalists to be announced Jan 04.
