FirstDerm is a company that crowdsources Consultant Dermatologists (Hospital Specialists in Dermatology) from the U.K. and Europe. They have an app that is freely available to patients who pay privately for an opinion usually about a mole that they are concerned about.
The South Cheshire and Vale Royal GP Alliance with Howbeck Healthcare’s support has worked with FirstDerm to create an application for GPs who need rapid advice. The application is a web app that can be installed on any smartphone or run on a computer in a browser. The easiest way to use it is on a smartphone with a built-in camera, but photos can be transferred to a PC to be uploaded if needed.
How it works - The GP runs the app and takes two pictures of the skin lesion or rash that they want help with, one close up and one from further away to show the distribution or location. Patient consent needs to be taken but they can be reassured the system is secure and meets all the information governance requirements for patient data.
Why we find it useful - The GP may be asking for diagnostic or treatment advice, or both. The service used in South Cheshire and Vale Royal GP Alliance isn’t a referral vetting service, though it could be used as that. We have aimed it as a rapid advice line for GPs who would like help but don’t want the hassle of trying to get hold of a consultant by phone, or where there is no real advice and guidance service operating and where a formal referral would be too expensive or take too long.
The information we input - On the app the GP (or other clinician at GPs recommendation) completes some basic information about the patient and condition e.g. some background, what’s already been tried as treatment and crucially the help they need or advice they want. They then upload the case to the cloud.
Response times are good - Often within an hour, and usually within 24 hours an email comes back to the practice (and if requested the GP) saying the reply is ready. Usually an admin person logs on to the system and downloads the reply and workflows it to the GP via Docman or via the clinical system.
Feedback is positive - We have sent over a hundred cases and the local GPs find it very useful. Occasionally the advice has been to refer into local secondary care services but usually there is either diagnostic advice, treatment advice, or a suggestion that a biopsy is taken for further information – this biopsy to be done in primary care.
Most of the cases sent are for Gross Dermatology problems and the original idea was that every GP has a smart phone and can therefore utilise that in clinic or on home visits. There is the ability to send dermato-scopic images which can be better for helping diagnose moles in particular but other skin lesions too. This of course puts the cost up as although there are dermato-scopic gadgets that can be attached to smartphones these have a cost and the price of the good ones means it isn’t economic for every GP to have one. In one locality we have used some capital funding to purchase each practice a dermatoscope and they are trialling using the practice dermatoscope (either by going to get it – or by bringing the patient back for an image). This is also going well and the learning is to put some training into getting a good image as this reaps benefits.
It's cost effective and the patient experience is improved - There is a cost per referral that the Federation is currently paying for and we are trying to put the business case together for the CCG to commission the service directly. There is sometimes a concern by commissioners that this type of service raises demand and that costs will increase. Our experience is that this isn’t the case, GPs aren’t sending cases that they would have normally dealt with, they appear to be sending cases for advice that they normally would have referred. The speed of the advice is meaning less appointments in primary care – and less prescriptions for medication that don’t work. The patient's experience is improved, often receiving feedback within the day from their own GP, without the need for a referral to hospital.
We are exploring the possibility of Nurses using the app to record wounds and link to Tissue Viability services, and for community nurses to use the app to send images either to Tissue Viability or to the on-call GP for review, for example for antibiotics to save a home visit.
We are also looking at using the app as an appointment avoidance system with patients getting an opinion direct without needing an appointment – though we are trying to understand the costs of this.
Howbeck Healthcare and FirstDerm are happy to work with your practice / federation if you want to set the basic service up in your area or if you are interested in some of our future developments.