ESS Primary Care Solutions – Waltham Forest Community Dermatology Clinic

• Has gradually expanded to provide 16-18 clinics per week across 3 sites
• Provision of 3200 new, 2800 FU, 600 Dermatology surgery appointments p.a.
• Multidisciplinary team
  • 3 Consultant Dermatologist from Local secondary care hospital - Barts Health
  • 12 GPwSIs
  • 3 HCA’s
  • 10 Non clinical staff - administrative and secretarial team

• Silverthorn Medical Centre, Chingford, E4 6UN 
• Oliver Road Medical Centre, Leyton, E10 5LG
• ESS Clinic, South Woodford, E18 1AY

All sites are DDA compliant with good transport links.

• Appointments available AM, PM and weekends
• Mix of clinicians within the service – GPwER, Consultants, HCA
• Male and female clinicians available
• Booking office patient telephone line - Monday to Friday
• Clinical lead available at all times if clinical queries arise
• Reactive service - wait times monitored and extra clinics can be scheduled at short notice
• Telephone appointments available for follow-ups if patients unable to attend. Telephone reminders of appointments
• Range of patient information leaflets with details of voluntary organisations
• Information on website and leaflets available in different languages
• Sample boxes of emollients, giving patient choice on treatment

The community dermatology service has always had a low rate of referral into secondary care. The main reasons for this are:

1. Clear GP referral guidelines
2. Experienced GPwSIs – must have the diploma and 2 years’ hospital experience
3. Excellent working relationship with secondary care consultant colleagues
4. Skill mix within the team
5. Monthly Consultant teaching clinics, ensuring ongoing CPD and development for GPwSIs

• Information collated from regular audits, performance monitoring, PSQ
• Fully integrated service with Barts Health secondary care services
• Development of referral guidelines for GP’s
• Wait times for new patients < 6 weeks (cf 24 weeks in local secondary care)
• Surgical wait times < 6 weeks
• New/FU ratio 1:1 (cf 1:2.5 nationally)
• < 5% referral onward referral to secondary care
• Safe, cost-effective prescribing – development of a formulary with MM Team
• Low risk skin cancer service provided, with attendance at local MDT meetings
• See, treat and discharge 35% patients – one stop clinic
• No locums employed, continuity of care a priority
• Flexible and responsive to wait times and patient’s needs
• Patients can see a consultant within 4 week in the community (cf 24 weeks)

• Clinical lead : Dr Shereen Rahman, is one of the educational speakers for PCDS and RCGP and provides teaching locally to GP’s
• The service also provides teaching for GP registrars within Waltham Forest

• Development of referral criteria guidelines for GP’s
• Development of GPwER reference manual
• BCC skin cancer pathway
• Prescribing of Isotretinoin 
• Development of a Dermatology formulary in collaboration with MM
• Consultant teaching clinics – GPwER funded to attend
• Succession planning, robust induction programme
• Quarterly newsletters
• Two clinicians working alongside each other at all sites
• Extensive array of patient information leaflets - proactive health promotion
• Dermatology surgery available at all sites – building of minor ops room
• Career development – GPwER training to be a consultant
• Development of in-house patient leaflets specific to the service