Our Dermatology service has always been a very busy department with increasing demand for appointments.
In June 2016, we had a huge waiting list for new appointments, and 562 patients had been waiting over 35 weeks. This was the highest number for any of our specialities. We had consultant vacancies, roles that had remained unfilled for several years. Our patient satisfaction was very low and there was a high number of complaints, as well as queries to our PALS team, due to the extended waiting times. Our achievement against our cancer performance targets was also inconsistent and we had too many patients waiting over 14 days for their first appointment.
What did we decide to do? We ensured there was strong clinical leadership in place to help develop a strong, multi-disciplinary team.
As we had been unable to recruit to our medical workforce posts for some time, we decided to try an alternative approach. For example, we appointed a paediatrician with special interest in dermatology.
This allowed us to establish designated paediatric dermatology clinics from the Children’s Outpatient Department, meeting the needs of our younger patients. It also freed up capacity in existing clinics for new adult referrals.
We then appointed a sexual health consultant who was also qualified in dermatology. Now we had gained more capacity, we re-profiled our outpatient clinics and began seeing the patients who had waited the longest first. We now had strong managerial oversight of the waiting list, which made a big difference.
Daily tracking of patient pathways and outcomes after clinic was a gruelling but necessary task. We retrained our medical and nursing teams around RTT process and the importance of recording accurate outcomes after appointments.
To increase minor ops capacity, we first completed a small capital works project to convert a clinic room to a fully-functional minor ops room, doubling our minor ops rooms. We recruited three extra nurses with the intention of training them to complete procedures. Through their hard work and dedication, the highly-trained nursing teams were able to bring the minor ops waiting list down from approximately four months to only a few weeks.
Following a review of patient feedback, we developed ‘see and treat’ clinics so that patients could have their first outpatient appointment and then a minor op on the same day. Not only did this help our RTT and cancer performance, it also proved very popular with patients who no longer needed multiple visits to the Dermatology Department. This innovation won our department an award at our Trust’s annual PRIDE awards ceremony.
With all these initiatives and additional capacity, by March this year, our Dermatology service achieved 97.85 per cent RTT compliance. All cancer targets have been consistently met and for the last six months. Our patients’ experience has been much improved with we’ve seen a huge reduction in complaints and PALS queries.
Through April to June 2016, we were averaging 15 PALS queries per month. For January to March 2017, the average was two queries per month. All of this was achieved while we experienced increasing demand on our service.
Over our recovery period we experienced a 13.5per cent increase in referrals.
What next? We want to increase the number of ‘see and treat’ clinics.
We also want to reconfigure our outpatient clinic profiles to reduce the median waiting time for 2WW referrals.
We also want to review the feasibility of providing TeleDermatology services, increase patch testing clinics, introduce nurse-led dressings clinics and immunosuppression clinics.
From a manager’s perspective, it was an absolute pleasure working with an amazing team to develop a plan and then deliver it. Every member of the team has played a part in the recovery.
The safety and positive experience of our patients was at the heart of every decision.
Ben Conway,