BT03 Optimizing skin cancer referral pathways at the primary–secondary care interface: the role of a primary care skin cancer pathway lead

Abstract

Urgent suspected skin cancer referrals continue to increase in number, placing sustained pressure on secondary care dermatology services. Teledermatology is integral to managing this demand; however, its effectiveness depends on image quality, referral consistency and clinician confidence in lesion assessment. This service evaluation examined the impact of an innovative role of Primary Care Skin Cancer Pathway Lead and associated interventions. Over the past 18 months, our skin cancer pathway has benefited substantially from the introduction of a dedicated general practitioner with extended role (GPwER), assigned to improve links between primary and secondary care and to lead implementation of a structured package of interventions across primary care. These included dissemination of guidance on obtaining high-quality images, face-to-face training in clinical photography and dermoscopy, and the introduction of a simplified referral pro forma. Measures were also introduced to improve access to functioning dermoscopy equipment. Pre- and post­implementation data were collected to assess referral outcomes, image quality and clinician confidence in dermoscopy and lesion recognition. The results indicated a 61% reduction in referrals with inadequate or absent imaging, and the proportion of referrals discharged via teledermatology increased, contributing to a reduction in face-to-face secondary care appointments. Primary care confidence in dermoscopy and lesion recognition improved, resulting in the greater consistency and quality of submitted images. During a time of significant service pressure, a trusted GPwER working across the interface enhanced communication between primary and secondary care by representing the priorities and operational constraints of both settings, thus facilitating timely resolution of pathway issues and sustained engagement. This ongoing service evaluation demonstrates that the introduction of a specific primary–secondary care liaison role within the urgent suspected skin cancer pathway leads to improved care quality, communication and efficiency, and timelier access to care. The model described is transferable to other specialties where effective triage and collaborative working are essential.