Clinicians in Coventry and Warwickshire ICB have had access to Enhanced Advice & Guidance provided by Consultant Connect since 2016. The service rapidly connects them to specialists for speedy and thorough advice via Telephone, Photo and Messaging. We spoke with Dr Varadarajan Baskar, a Diabetes and Endocrinology Consultant at South Warwickshire NHS Foundation Trust, who provides Advice & Guidance to local colleagues, to find out how the service benefits him, his team, and the patients.
What types of queries do you receive?
‘I often get advice requests about a new diagnosis of diabetes, acute rise in sugar in known diabetes, diabetes and hypothyroid queries – either in new or existing patients with a change of situation (pregnancy, for example), and low sodium levels. With these types of queries, I will often give them first-level considerations of differential diagnosis and appropriate diagnostic work-up and referral thresholds.’
What advice would you give to specialist colleagues who are not yet providing advice via Consultant Connect?
‘Give it a try. The benefit to the patient is only one of the values of the service. The passive education and knowledge-sharing with the calling clinician will hopefully become applicable to many more patients who present to them with similar conditions.’
Does answering calls impact your workload?
‘I only answer calls when I’m available. The rota system means that if I’m not available to answer a call, the system automatically moves on to the next person on the rota. The service data is reassuring as it tells us that within 30 seconds, one of us is answering a call and that the average call length is about four minutes. By answering calls via Consultant Connect, I know I am rapidly helping the caller and their patient.’
We also spoke with Dr Andreas Photiou, a GP in Coventry and Warwickshire ICB, to find out how he uses Photo Advice & Guidance to send imagery to specialists for advice.
‘Before the introduction of Consultant Connect, I did not often take clinical photos. I now regularly use the clinically safe photography feature, PhotoSAF, within the Consultant Connect App to send photos for advice. I would strongly recommend using the app to take good-quality photos under good lighting – using a paper ruler for scale also helps. Clinicians must include sufficient clinical information, such as the skin type of the patient or their previous sun exposure history. There did not appear to be a deterioration in the quality of the photos taken via the app.’
‘I recently spoke with a local GP who was seeking advice about a patient with Type 2 diabetes. They wanted rapid advice because the patient’s control had fluctuated rather considerably. The GP explained the patient’s history and asked whether they ought to consider scans for the patient to exclude malignancy.
I was able to reassure both the GP and the patient that the fluctuations were likely caused by patient-initiated changes to lifestyle, which the GP subsequently confirmed after reviewing practice nurse notes, and so I didn’t need to consider any scans for the patient.’
‘A patient came to see me with a cutaneous horn-type lesion on his upper chest. The patient had a history of fair skin and sun exposure, so I was concerned that the lesion might be an early Squamous Cell Carcinoma (SCC). I sent a photo via the Consultant Connect App, with the patient’s consent, for Dermatology Advice & Guidance. The consultant agreed that it could be an early SCC and advised a two-week wait (2WW) referral.
I was able to share the image with the consultant, and I received a response within the hour containing their clinical advice. Putting the patient forward for a 2WW referral was the best result because it fast-tracked the referral and meant that the condition was being managed efficiently.’