P064 Impact of the professional role of referrers on dermatology referral outcomes: a 2-year audit across two Welsh health boards

Abstract

Dermatology services face rising demand alongside increasing involvement of nonmedical professionals in primary care pathways. While multidisciplinary care is essential, the implications of non-doctor-initiated referrals to dermatology require evaluation, particularly with respect to referral quality and service efficiency. The aim of this study was to assess acceptance rates of dermatology referrals by the professional role of the referrer and to evaluate the impact of feedback and guideline reinforcement on referral outcomes. A retrospective audit was undertaken of dermatology referrals across the Swansea Bay and Hywel Dda University Health Boards. Referrals from two time periods (2022 and 2023) were analysed. Data collected included referrer role (doctor, nurse, physician associate) and referral outcome (accepted or returned). Between audit cycles, referrers received targeted feedback via the electronic referral system alongside reinforcement of local referral guidelines. In total, 100 referrals from 2022 and 148 referrals from 2023 were analysed. In 2022, 87% of referrals originated from doctors, 8% from nurses and 5% from physician associates (PAs). Overall, 47% were accepted. Acceptance rates were highest for doctor referrals, while nurse and PA referrals had acceptance rates of 13% and 20%, respectively. In 2023, 86% of referrals were from doctors, with an overall acceptance rate of 59%. Acceptance rates improved among nondoctor referrers but remained lower than those from doctors (nurses 38%, PAs 28%). Referrals initiated by doctors were more likely to be accepted than those from nondoctor professionals. Although targeted feedback improved referral quality, significant disparities persisted. These findings support a doctor-led referral model to optimize dermatology service efficiency, preserve specialist capacity and minimize delays for patients requiring secondary care.