P191 Optimizing 18-week dermatology pathways: locum-led vs. in-house dermatology team performance and impact on patient flow

Abstract

Many UK trusts increasingly rely on locum clinical teams to manage escalating dermatology waiting lists, particularly within 18-week pathways. As these teams are embedded in cancer and surgical triage pathways, it is important to understand how their clinical decisions and surgical outcomes compare with those of in-house staff. This study evaluated conversion rates from clinic review to surgery in 18-week locum-led vs. in-house dermatology teams, and assessed the frequency and nature of procedure changes or cancellations occurring on the day of surgery. Part 1 of the study was a tumour clinic: 100 consecutive 18-week clinic referrals from July 2024 were reviewed. Recorded data included referrer concerns, clinician differential diagnosis, onward referral pathways (urgent vs. nonurgent), planned vs. performed procedures and final histology. The findings were compared with 100 in-house tumour clinic referrals. Part 2 was a theatre audit of 200 consecutive surgical cases (July 2025). Extracted data were referral source (18 week vs. in house), differential diagnosis, intended and performed procedures, and final histology. The 18-week team referred a higher proportion of patients for procedures than in house (50% vs. 44%), with more frequent choice of excisions (80% vs. 56%). Procedure changes were more frequent in the 18-week cohort: 32% of excisions altered compared with 20% in house, with overall change rates of 40% vs. 24%, respectively. Cancellations were also higher (13% vs. 9%, respectively). Theatre audit data reflected similar trends, with 31.8% of 18-week-booked procedures changed on the day compared with 7.5% for in house. Significant differences in surgical planning and day-of-surgery changes highlight opportunities to improve patient flow, theatre efficiency and pathway consistency. Implementing shared guidance on procedure selection, establishing feedback loops and keeping referring consultants informed of changes could enhance continuity. Observed variability likely reflects structural factors in locum-led models, such as limited familiarity with local protocols and follow-up systems. System-level interventions could optimize efficiency and outcomes across both the 18-week and in-house pathways.