Congratulations are in order for Dr Rabi Nambi, NHS Consultant Dermatologist, who was presented with the British Association of Dermatologists (BAD) Dermatology Clinician of the Year Award on 3rd July at the annual meeting in Glasgow. Alongside his NHS work, Dr Nambi is a Senior Medical Advisor for Consultant Connect and has been a part of our National Consultant Network (NCN) since 2020, supporting NHS areas with Dermatology Advice & Guidance (A&G) and Referral Triage and Validation. We sat down with Dr Nambi to find out why he enjoys working with Consultant Connect and the benefits this has on the wider NHS:
What appealed to you about joining the NCN?
‘From the beginning, I knew that working with Consultant Connect would produce some very meaningful results, which really interested me. I had felt for a long time that there were patients across the country who needed dermatological treatment, and all it would take for many of them to get better was a specialist to review their condition and provide management plans via their general practitioner. Access to dermatology provision across the UK is so varied because in some areas, there is a complete shortage of consultant dermatologists. For those hospitals, the consultant dermatologists on the NCN can be the only ones contactable for advice.
There are more than 2,000 skin diseases, and I always tell my trainees that different things are similar, and similar things are different. So, a condition that can appear different from another might be an alternative presentation of the same ailment, and vice versa. This is why dermatology can be so challenging for primary care clinicians.
‘The NCN’s positive impact has meant that we can collaborate with primary care teams to formulate patient management plans to improve their wellbeing quickly, and that’s the real benefit.’
What do you like about providing A&G on the NCN?
‘I think an element that isn’t highlighted enough is the education of the physician seeking advice. Many GPs don’t cover dermatology as part of their training, although dermatological conditions tend to make up 15-20% of primary care workloads. So after five years of studying medicine, and three years of GP training, the maximum amount of time a GP might’ve spent on dermatology is two weeks, and that’s to help them tackle up to a fifth of their patients. Because of this, GPs might not be as confident in treating dermatological conditions, and it’s therefore unsurprising that there is a lot of undertreatment in this area. So, if the GP has access to rapid A&G and gets an immediate response advising them of how to manage this particular condition, the next time they see a patient with that same issue, they will feel more confident in prescribing a stronger treatment to help the patient. For this, the GPs and the patients are very grateful. In my experience, when I speak to GPs I’ve advised previously, they’re more often than not referencing regimes I’ve already recommended, so I’m finding that this access to A&G helps them to initially treat like a consultant. This, in turn, leads to them making fewer referrals. The educational aspect of Consultant Connect is undervalued, and it needs to be highlighted.’
Dermatology is a specialty that has one of the highest waiting lists nationally, because it’s understaffed and over-referred. How does your Referral Triage work support with this problem?
‘Referral Triage is beneficial to the NHS because the triaging consultants filter out the patients who do not need to be seen by a specialist, whilst giving initial treatment advice. For example, in dermatology, I frequently see referrals for patients with discoid eczema or actinic keratosis, whereby the patient would be prescribed medication at their initial appointment and then, at their follow-up appointment, if their condition had cleared up, they would be discharged. By safely removing these patients from the waiting list and advising the GP on the treatment plan, we reduce avoidable face-to-face appointments in secondary care.
‘Additionally, upon reading the advice, the referring clinician learns the specific treatment that can be prescribed for a particular condition, ultimately leading to more appropriate and better-quality referrals in the longer term.
‘There are also many serious conditions referred on routine pathways which should be expedited, and conducting triage allows us to pick these out and advise the hospital that they need to be seen in two weeks – in some cases, I’ve even phoned the hospital and advised them to see the patient within 48 hours. As a result, Referral Triage and Validation has enabled us to identify many skin cancers which shouldn’t be on that waiting list.’
What would you say to NHS hospitals/trusts looking to maximise their potential with Referral Triage and Validation with dermatology?
‘Engage with the consultants carrying out the triage. Give us set pathways and guidelines, which Consultant Connect can work into the framework, so that patients can be allocated to these clinics. For example, a current Referral Triage project I am working on gives me access to 15 available clinics, run by various specialist clinicians, where patients can be slotted in. I know these clinics because of the close cooperation with the trust’s consultants. The more you engage with the Consultant Connect team, the more you benefit from the process.
‘Sometimes, on initially meeting clients, they seem to feel that not much can be done for their waiting lists, and that they’ve exhausted all their options, but they are always pleasantly surprised on the level of tests we can do, both in the initial treatment and in the referral to the appropriate clinics. Throughout the entire process, we want to triage patients into the appropriate clinics, run by the appropriate clinicians, so that all available pathways are utilised to the full extent, and the clients are always very happy with the results.’
Do you still enjoy providing A&G and triaging referrals with Consultant Connect?
‘I love it. In some parts of the NHS, there is no local dermatology provision, and there is no one to refer to or seek advice from, so primary care clinicians end up referring to a hospital that can be many miles away from the patient’s home. This is why some of the UK’s waiting times can be years before a first appointment is scheduled. So, if those patients are referred, they’ll have to wait to be seen; instead, I can use my specialist knowledge to improve their quality of life without needing a hospital appointment. That makes me feel that what I have done so far, all of my training, is worth it and has value. When I see a patient with a severe dermatological condition, I know the treatment I advise the GP to prescribe will improve them within a few weeks. And that’s the satisfaction of doing this job.’
Related materials:
