Chair's June Update

Dermatology Update 
 

Dermatology attended this month’s LMC meeting in order to discuss mandating photographs to accompany dermatology referrals. This is due to the fact that referral rates are increasing, there are long wait times for outpatients and expedite letters are increasing.  LMC were pleased that as part of the discussion dermatology had reconsidered their position prior to attending and were requesting photographs but not looking to mandate (which they would have been unable to do). There was a debate on this and cases were presented where photographs had helped to provide timely advice and guidance with no need to wait for outpatient appointment. It was also raised that this is an extra request of GPs and another creep of workload shift from secondary to primary care. Therefore the request is not mandated, GPs can include photographs with a referral if they wish but they don’t need to and if photographs will potentially help then they are able to request them from the patient. 

It was important to note that 4% of lesion referrals do not mention the location of the lesion. This is obviously important information for dermatology to have when trying to triage and prioritise referrals. The referral examples that LMC looked at contained mostly cases which should have been managed solely in primary care and were referred in unnecessarily by allied health professionals. LMC feels that it is important that partners are aware of the referrals being made from their practices to avoid further increasing the waiting list size.  

Dr Pamela Cribb is happy for GPs or allied health professionals to observe her general dermatology clinics for educational experience. Please contact Dr Cribb pam.cribb@wales.nhs.uk if you are interested in attending a clinic.  

Primary Secondary Interface
 

Whilst it is really important to ensure that the communication standards are not being breeched it is also really important to ensure that secondary care are able to flag potential deterioration in GP-managed chronic diseases, the same as we would flag to hospital consultants if a patient under their care got worse. An example this month was where a patient attended a pre-op clinic and it was found that both the HBA1c and the EGFR had deteriorated slightly. LMC is happy that these are conditions mostly managed within the remit of primary care and therefore it is outside the remit of the pre-op clinic to optimise patient medications or undertake further investigation in those areas.