BT06 Introduction of a medical photography hub to optimize phototriage of 2-week-wait referrals

Abstract

Waiting times for 2-week-wait (2WW) referrals remain challenging. For a number of years a nonmandatory phototriage pathway has been available to primary care for 2WW referrals, providing both macroscopic and dermoscopic images. An audit of 2WW referrals in 2024 demonstrated that only 30% were received via this pathway and poor image quality was a consistent finding. We aimed to establish a medical photography hub to address both the relative lack of primary care engagement with phototriage and poor image quality. All 2WW referrals received without images and those with poor-quality images were invited to attend the medical photography hub for macroscopic and dermoscopic images. Consultant triage was then undertaken. A reaudit was performed in 2025 over a 3-month period following introduction of the hub, and the data compared with 2024 triage outcomes over the same 3-month period. The number of 2WW referrals remained stable, with 1183 received in the 3-month period in 2025 and 1150 in the same period in 2024. Overall, 98% of invited patients attended the photography hub. Following consultant triage in 2025, 39% of 2WW referrals were discharged and 5% were downgraded, resulting in a total of 44% being removed from the 2WW pathway at the point of triage. In 2024 only 4% were discharged, 1% downgraded and 5% removed from the 2WW pathway. A medical photography hub has addressed both limiting factors of the previous phototriage pathway. Firstly, 98% of patients demonstrated engagement with the hub, and secondly, as a result of the high-quality images, 44% of 2WW referrals were removed from the pathway at the point of triage. Increased consultant triage workload was required for this hub model but this was offset by a reduction in both the number of 2WW outpatient appointments required and 2WW waiting times.