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GPSI dermatology scheme a success

How a service in Exeter is bridging the divide between primary and secondary care.

Dr Chamberlain enjoys being a GPSI and finds the hospital consultants she works with very approachable
Dr Chamberlain enjoys being a GPSI and finds the hospital consultants she works with very approachable

Dr Victoria Chamberlain's dermatology GPSI clinic at the Heavitree Health Centre in Exeter is an excellent example of successful collaboration between primary and secondary care clinicians.

The clinic was set up under practice-based commissioning (PBC), and most patients referred are from Exeter, but referrals also come from east and mid-Devon.

Before becoming a GP part-ner, Dr Chamberlain was already a clinical assistant in the dermatology department at the Royal Devon and Exeter hospital. As a partner, her brief was to set up a dermatology clinic at the surgery.

'I had been doing skin cancer work within plastics and dermatology, so this work is a continuation of that,' she says, adding that she really enjoys being a GP and having a specialist interest.

Relationship with hospital
She spends two half-days a week at the hospital doing a skin cancer clinic and a surgical list.

'What I do in the surgery is an extension of what I do in the hospital. It gives the surgery good, close links with the dermatology department and assists with governance issues,' she says.

The dermatology department trained the clinic nurse assisting at the practice clinic free of charge and Dr Chamberlain says the consultants are extremely approachable. 'I can easily ask if there is something I am not sure about,' she says.

Her dermatology work is in a niche area, concentrating on low-risk skin cancers, precancerous skin lesions caused by general sun damage, difficult pre-malignant lumps and bumps and sebaceous cysts.

She does not do melanomas or squamous cell carcinomas. However, she will remove a squamous cell carcinoma if a case is accidentally referred to the practice clinic, provided the patient is happy for the procedure to be done in primary care.

'Rather than delaying surgery, it is in the patient's best interest. However, these incidents are few and far between', she says.

Business plan
The practice service was the result of NHS Devon working with local GP surgeries through PBC to reduce the cost of secondary care referrals. Set-up expenses, together with the cost of running the clinic for a year, were around £33,000.

Details in the PBC business plan put to the PCT included what the clinic would involve, likely numbers of patients per year, anticipated costs (such as Dr Chamberlain's pay, costs for equipment, room charges, nurse hours and administration time) and estimated savings.

The actual savings have yet to be calculated, but are expected to be significant. Six patients can be treated at each three-and-a-half-hour session and there are 44 sessions a year.

The procedures Dr Chamberlain performs are cheaper to carry out in primary care and also shorten the consultants' waiting lists.

Dr Chamberlain believes that there is scope for more practice-based GPSI clinics.

'The consultants I am working with do not think that they are losing out on work, partly because the incidence of skin cancer in the South West is increasing, so any sessions done by GPSIs help to chip away at a growing list.'

Dr Chamberlain adds that more dermatology GPSIs are needed for practice clinics.

Patients attending the Heavitree clinic say they prefer not to go to the hospital because they save time and parking costs and appreciate being seen quickly.

A key part of the service is triaging referral letters from GP practices. Dr Chamberlain says this can sometimes be difficult, because the referring GP may not know exactly what they are sending the patient to her for, other than 'something that needs to be looked at'.

The problem may be outside her remit and, if so, the referral is returned to the GP. Where possible, she will point out where they do need to send the patient.

Dr Chamberlain says that being a GPSI is good for GPs who have a greater variety of work, good for patients, fosters closer links with secondary care and saves the NHS money.

'More people are going part-time so they can do this, and more partnerships are considering GPs who have extra skills so they can bring in something different.'

DERMATOLOGY CLINIC

  • A practice-based commissioning initiative, based at the Heavitree Health Centre, Exeter taking referrals from GPs in Exeter and mid- and east Devon.
  • Cost around £33,000 to set up and to run for a year.
  • Significant savings expected from fewer referrals to secondary care.
  • One morning session a week at the practice seeing six patients; 44 sessions a year.
  • Treatment for low-risk skin cancers and precancerous skin lesions caused by sun damage, difficult pre-malignant lumps and bumps and sebaceous cysts.

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