A rural dermatology outreach service – a new model

Purpose The dermatology service on the islands of Orkney, with a population of approximately 22,500, was taken over by National Health Service (NHS) Tayside in August 2018. This paper aims to provide an overview of the planning and review of a highly efficient and effective dermatology service for a rural island population. Design/methodology/approach The service includes visiting dermatology consultants, enhanced electronic referral vetting, skin surgery services, a General Practice (GP) with extended role (GPwER) in dermatology, specialist virtual clinics, urgent advice for inpatients at the local district general hospital and remote systemic therapy monitoring. A new phototherapy service has been set up in an island GP practice. Findings Local GPs and consultant dermatologists find the enhanced vetting service useable, efficient and educational. Between August 2018 and November 2022, there have been 1,749 referrals. Of these referrals, 60% were seen in clinic or a GPwER surgery, with 40% managed remotely by providing advice back to the referring GP. The number of consultations performed by the GPwER has grown over the past 3 years, and in the last year, it accounted for more than 50% of patient appointments. The waiting time has been significantly reduced using this model. Originality/value This remote service uses an integrated approach of teledermatology (TD) whilst offering continual in-person services using local capabilities including a GPwER and island general surgeons. New treatment facilities are provided to the island population. Continual educational feedback to the primary care referrer is provided, and it enhances relationships that greatly aid the high-quality dermatology service provided.