P219 Upskilling the teledermatology workforce: demonstrating a safe, high-quality Advanced Clinical Practitioner model for remote skin cancer assessment

Abstract

Teledermatology has become an essential tool for timely assessment, yet its effectiveness is limited by the number of clinicians trained to deliver high-quality remote triage. This project describes an innovative model to expand workforce capacity by upskilling a trainee Advanced Clinical Practitioner (ACP) to undertake skin cancer teledermatology assessments within a structured governance framework. Building on the existing ACP training pathway, an enhanced dermatology-focused curriculum was developed incorporating dedicated consultant supervision, dermoscopy and lesion-recognition training, weekly image-review clinics, participation in multidisciplinary team meetings, and competency-based assessments aligned with national standards. A phased approach to independence was adopted, with all early assessments reviewed by a supervising consultant and a prospective audit of diagnostic concordance embedded from the outset. Clear escalation pathways, peer review and reflective practice further supported safe clinical decision making. Over a 3-year period (2022–2025), within a busy skin cancer specialist centre receiving just over 16 000 urgent suspected cancer referrals annually (2025 data), the trainee ACP reviewed more than 6500 teledermatology cases. They achieved an average diagnostic concordance of 90.9% with supervising consultants and no missed malignancies. This model delivered substantial service benefits, including increased assessment capacity, reduced waiting times, and improved patient flow to meet the Faster Diagnosis Standard. Additional advantages included enhanced workforce flexibility through remote supervision, enriched educational opportunities for wider team members, and improved continuity for complex cases through combined digital and face-to-face review. Key challenges included building diagnostic confidence, ensuring sustained supervisory input during early stages, and addressing public perceptions of the ACP role within skin cancer services. Nonetheless, the programme demonstrates that, with robust governance and structured support, ACPs can make a safe, effective and sustainable contribution to skin cancer teledermatology. This model offers a scalable solution to national workforce pressures and highlights the strategic value of investing in advanced practice roles within dermatology.