There are 7 different ways in which referrals can be made to the department
- Skin lesion 2 week wait (2WW) referrals for suspected cancer – e.g. melanoma, SCC, high risk BCC
- Skin lesion referral assessment service (RAS) (for 16 yrs+) – No A&G available
- Adult dermatology RAS (includes inflammatory skin disorders). A&G also available.
- Genital dermatology RAS
- Paediatric dermatology RAS (suspected ca still refer 2ww). A&G also available.
- Dermatology advice and guidance (A&G)
- Referrals requiring urgent face to face assessment (same day or within the week)
Routes 1 to 6 are accessible via electronic referral via e-RS and route 7 is via telephone call via RCHT switchboard.
Requirements for referral:
The common requirements to access all routes to dermatology are:
1. Referral letter with full clinical history and relevant past medical history
2. Patient profile listing medical history, drugs and allergies
3. If appropriate, good quality clinical images (no more than 5) pasted into a single word document and uploaded as a single attachment.
4. Clearly labelled attachments to electronic referrals for example “referral letter”, “profile” and “image” etc.
5. Appropriate patient consent for image sharing
Please consider attaching high quality images to every referral as this allows triage and streamlining of patients to the right place, first time and avoids unnecessary outpatient appointments.
1. Referral accepted, patient added to waiting list and appointment sent in due course including the potential for non-face to face appointment
2. Referral returned with brief comment if doesn’t meet acceptance criteria
3. Advice to GP regarding ongoing management in primary care
4. Conversion of advice and guidance request to formal referral if primary care options are felt to have been exhausted (provided referral conversion enabled by referrer)
- Genital dermatology or rash in a ‘sensitive’ area – especially NEVER take/share pictures of genitals/sensitive areas in those under 18 years (as this could be considered a criminal offence)
- Referrals for patients moving into the area following cancer treatment who require follow-up treatment
- patients with no visible cutaneous abnormality e.g. pruritus without a rash, hyperhidrosis
- patient or parent declining photo
Please use Consultant Connect to take clinical images. Consent is in built and the app is fully compliant with information governance standards.
- (Guidance on how to use Consultant Connect and how to take a high quality clinical image is found here)
Patient images – AccuRx/eConsult more secure than e-mail. Please ensure that the images are of sufficient quality if forwarding onto Dermatology and that permission has been given.
- Referrals for conditions which fall under the procedures of limited clinical benefit policy and those where local guidelines suggest management in primary care, will be returned back to the referrer.
- Sebaceous cysts - Excision of sebaceous cysts are not routinely commissioned as outlined in the benign skin lesion commissioning policy. Do not refer unless they meet exclusion criteria. If they are referred for a diagnosis, please inform patient it will not be removed if it appears benign.
- Efudix/Imiquimod cream - please delay referral until the acute inflammatory response has subsided (4-6 weeks following cessation of treatment) and outcome of this treatment has been assessed, as referral may not be needed.
- Referrals of pigmented lesions via the lesion RAS will generally be returned and the referrer advised to make a 2WW referral.
DERMATOLOGY ADVICE & GUIDANCE (any age)
- To be used for all patients with non-lesion skin problems for whom diagnosis and management advice is required; it is assumed that the GP will continue to manage the patient in primary care.
- Not to be used if patient requires secondary care face to face review – in this case refer via one of the RAS pathways.
- Conversion to referral will only occur in rare cases if primary care options are felt to have been exhausted (provided referral conversion enabled by referrer)
- This service should not be used for lesions. If a lesion referral is received via this route the following automatic reply will be generated:
- Advice and guidance is not appropriate for 1-day old rashes, please allow for evolution of rash as this can be helpful in diagnosis.
- Please double check quality of photos - if you can’t make out the skin rash, it is unlikely that secondary care will be able to help much either.
Review date March 2022
Next review due March 2023
Reviewing GP Dr Madeleine Attridge