Background and challenge
In November 2024, a front-door USC dermatology triage project was launched, whereby when a patient presents with symptoms suggestive of skin cancer, the clinician takes the necessary images and makes a referral to Sheffield Teaching Hospitals NHS Foundation Trust (STH). An out-of-area NHS consultant dermatologist on Consultant Connect’s National Consultant Network (NCN) then triages the referral and images, and either accepts the referral to commence on its journey to STH, or returns the patient to the referring clinician with a detailed management plan. The success of the USC pathway project led to its expansion to include routine dermatology.
Like many NHS organisations, STH was managing a routine dermatology referral backlog. The Trust faced three key questions:
- Did all of these patients still require a routine dermatology appointment?
- If so, could better information, including updated images, be gathered to improve triage and optimise resource allocation?
- Due to the limited capacity of the local clinical dermatology team to review and triage patients on the waiting list in a timely manner, what outside resource could support with this?
Find out more about the project below:
Solution
In just 12 weeks, more than 3,500 patients (3,554 total) were contacted via the text message solution. Each patient was asked whether they still needed their dermatology appointment. If not, they could provide a reason, such as the condition having resolved or they having received care elsewhere. If the patient still required an appointment, they were prompted to describe their condition in detail and securely upload current photographs of the affected area.
All responses, along with non-responses and those missing images, were reviewed and triaged by expert, out-of-area NHS consultant dermatologists on the NCN. Acting as ‘virtual locums’, the consultants assessed the updated cases, reviewed the original referrals, and wrote comprehensive management plans for patients who could be safely removed from the waiting list and returned to primary care. The flexible nature of the NCN allowed Consultant Connect to increase the number of triaging consultants to manage demand and meet deadlines across differing worklists. This process ensured that only patients with an active need for specialist care remained on the waiting list and were prioritised based on clinical urgency, enabling STH-based specialists to focus on their patient-facing clinics.
Approach and implementation
- Rapid mobilisation: Within 12 weeks of initiation, the entire pathway was designed, implemented, and executed at scale.
- Patient-centric digital engagement: Using SMS communication in the form of Patient Access, patients could respond securely at their convenience, without needing direct hospital contact.
- Bespoke clinical workflows: The digital proforma was customised to collect the exact clinical information needed to enable effective triage.
- Out-of-area clinical expertise: Sheffield’s dermatology team was supplemented by Consultant Connect’s NCN consultants, ensuring the local dermatologists could focus on delivering care while waiting lists were validated remotely and efficiently.
Clinical safety and governance: Every response was clinically reviewed, and appropriate next steps were determined for all patients, including safe discharges and prioritised appointments.
What worked well
- High patient engagement: 71% of patients (2,533 total) responded to the Patient Access text, an outstanding rate for mass digital communication in healthcare.
- Effective clinical validation: 34% of all contacted patients (1,111 total) were safely removed from the waiting list following triage. This included:
- 222 patients who self-identified that they no longer needed specialist dermatological care.
- 889 patients who were redirected to alternative services or safely returned to primary care, backed by detailed management plans.
- Alleviation of local pressure: The involvement of NCN consultants drastically reduced the workload on the Trust’s dermatology team, enabling them to focus on face-to-face clinical delivery.
- Improved resource allocation: With fewer unnecessary appointments, clinicians can spend more time on the patients who need it most, improving quality of care and efficiency.
Benefits and impact
The project’s outcomes are profound and have transformed the existing pathway considerably:
- Streamlined patient care: A third of patients were safely removed from the waiting list, meaning faster appointments for those with genuine clinical need.
- Enhanced data quality: Triage decisions were made using high-quality, patient-submitted images and detailed symptom descriptions, data that was previously unavailable.
- Workforce optimisation: By leveraging remote consultants, the Trust increased its clinical capacity without diverting local clinicians from frontline care.
- Patient empowerment: Patients were given a voice in their care, reducing unnecessary hospital attendances and ensuring services matched their current needs.
- Impactful results: The project’s success and efficiency led to STH becoming the best-performing Trust in the ICB and, as a result, to re-commissioning Consultant Connect’s Referral Triage and Validation solution across both USC and routine dermatology referrals.
‘Re-triaging patients prior to consultation is really important. It ensures that care is both timely and appropriate, allowing us to prioritise those with the greatest need while reducing unnecessary appointments.’ – Dr Zainab Jiyad, NHS Consultant Dermatologist on the NCN.
The project today
Since its launch nearly 4,000 routine dermatology referrals* have been triaged to date, resulting in:
- 37% redirected to community-delivered services
- 31% safely removed from the waiting list and returned to primary care with detailed treatment plans
- 27% accepted for routine appointments
- 4% upgraded to urgent appointments
- 1% upgraded to USC appointments
* Stats correct as of August 2025
If you would like to discuss how we can help you in your NHS area, please email hello@consultantconnect.org.uk or call 01865 951207
