Teledermatology Across the NHS: Results From Six Systems

GP referrals to dermatology have risen sharply since Covid-19, for both suspected skin cancer and routine conditions including psoriasis, eczema and acne. Many NHS services still book patients straight into an outpatient appointment, even though a large share could be triaged remotely if the right images and clinical information were available.

The Cinapsis teledermatology pathway addresses this at the point of referral. GPs send high-quality images and structured clinical details securely to a consultant dermatologist, who either advises on management in primary care or books the patient into the clinic. Structured templates ensure mandatory clinical questions are answered before submission. Consultants can message the GP, move to a video call, or pick up the phone if a case warrants it. Two-week-wait referrals can be image-triaged before any appointment is booked.

Cinapsis is currently running teledermatology pathways across seven ICB regions. The results below come from six of them.

Black Country

The average wait for routine dermatology in Black Country fell from six months to six weeks.

Dr James Halpern, Consultant Dermatologist and Clinical Director of Dermatology at Walsall Healthcare NHS Trust and the Royal Wolverhampton NHS Trust:

"I use Cinapsis and eRS on a daily basis. I find the Cinapsis system much easier to use and more intuitive. It also has the advantage of being accessible on any device with internet access and does not require a VPN and smartcard to access like eRS. When undertaking teledermatology I am able to review all the information and photographs on a single webpage, making analysis and outcoming of the case much quicker. 

“We have also been able to add in standard responses to common queries, saving further time. Our Cinapsis-based teledermatology system has saved over 4,000 new patient appointments since being introduced, reducing waiting times for those patients with cancer that need to see us. It has also been a valuable educational tool, giving rapid feedback to referrers."

Gloucestershire

Every two-week-wait dermatology referral in Gloucestershire now undergoes image triage before any appointment is booked. 70% of all dermatology referrals are managed without a face-to-face outpatient appointment.

The mandatory image triage of two-week-wait referrals changes the clinical safety picture. Patients with high-risk presentations are escalated immediately. Patients with low-risk lesions are reassured quickly. The decision is based on what the consultant can see, rather than the GP's written description of what they saw.

Dr William Porter, Consultant Dermatologist at Gloucestershire Hospitals NHS Foundation Trust:

"Cinapsis halves the time it takes to access Advice and Guidance. It's far, far easier to use, it's modern, it's user-friendly, it's clear. All the case and patient details are on one page, meaning that you can do more with it, and see more patients."

Dr Tom Millard, Consultant Dermatologist:

"Cinapsis is a pleasure to use: it's all in one and laid out really simply. I find it much quicker and simpler than the painful process of Advice and Guidance in eRS."

Dr Mark Porter, GP and medical correspondent for BBC Radio 4's Inside Health and The Times:

"Saw patient with suspicious skin lesion. Sent summary and 3 photos via app to dermatology team. Diagnosis and management back within 1 hour. Impressed."

You can read more about how Cinapsis supports the Gloucestershire pathway here.

Cheshire and Merseyside

49% of dermatology cases in Cheshire and Merseyside are now managed through advice and guidance alone, without a referral to secondary care.

Dr Stephanie Gallard, Primary Care Lead:

"Historically, my GP colleagues and I had to waste hours wrestling with clunky, poorly-integrated photo-sharing technologies if we were able to attach photos at all in a data-compliant manner. Aside from the heavy burden it was placing on our time, this was leading too many dermatology referrals to be made without high-quality images. 

“This meant that patients were often called in for a face-to-face specialist appointment when they did not need special treatment, or when they could have been more appropriately managed in primary care. 

“Now that I can use the Cinapsis platform to manage patient referrals and access specialist second-opinions within days, I've been able to work more efficiently and treat patients more effectively. The entire referral process is now faster and more accurate: this means that my patients receive the right care, first time around."

Dr Richard Azurdia, Consultant Dermatologist at Liverpool University Hospitals NHS Foundation Trust:

"As a consultant dermatologist, receiving high-quality images attached to every patient referral and advice and guidance request is incredibly helpful. I can quickly review all the necessary information and make an informed, collaborative decision with the referring GP — without the endless email chains. With the Cinapsis platform available on my phone, laptop, iPad and PC, I can manage all referrals and requests through a single, integrated interface — whether in my office or on the wards."

Frimley (with clinical support provided by Xyla)

In Frimley, working with Xyla, consultant dermatologists assess routine referrals remotely through a medical photography clinic. Two-week-wait referrals sent to secondary care fell by 40%, and 40% of all referrals are now managed in the community or by the GP.

Rather than GPs capturing images at the point of referral, patients attend a photography session where a clinical photographer takes standardised, high-quality images. Those are reviewed by a consultant dermatologist through Cinapsis. The model produces consistently high image quality at the cost of an extra step for the patient, and delivers results in line with other Cinapsis teledermatology deployments.

“Our clinical photography team takes the pressure off GPs to capture images themselves. The images are consistently good enough for us to make a decision first time, which means far fewer cases going back and forth between primary and secondary care.” James Harplen, Consultant Dermatologist 

What the results show

The four systems above use different pathway designs, serve different populations, and started from different baseline positions. The outcomes aren't identical — but the direction is consistent. Fewer unnecessary referrals. Shorter waits for the patients who do need to be seen. Clinicians on both sides of the pathway reporting that the system is faster and more useful than what it replaced.

Dr Alex Anstey, Consultant Dermatologist in Bath and Swindon and Wiltshire:

"Cinapsis has, quite simply, changed my practice beyond recognition. Having used Cinapsis myself for over six months now, I've been impressed by its functionality and the fact it can be customised and tweaked to suit each individual unit. By far, one of the best features is that it is integrated with GP and hospital patient records — this is just invaluable."

North Norfolk's near-80% reduction in unnecessary referrals and Gloucestershire's 70% diversion rate represent what the pathway can achieve when it's well designed and properly embedded. Read more about what good Advice & Refer implementation looks like, or find out how Cinapsis supports the broader referral pathway.

To discuss what teledermatology could look like in your ICB or trust, get in touch with the Cinapsis team.

‍