Community Dermatology Service

Overview

The Community Dermatology Service run by Sirona accept referrals for adults and children registered with a GP in Bristol, North Somerset and South Gloucestershire who have failed to respond to primary care standard treatments. 

The following resources can support management of patients in primary care and should be considered prior to referral:

• Dermatology Remedy Pages
• The Primary Care Dermatology Society | UK
• Derm Net NZ

Appointments

The service can offer appointments either remotely or face to face in their clinics, as well as home visits for people who are housebound or unable to attend a clinic.

The Team

The team consists of GPs with Extended Roles (GPwER) in Dermatology and Dermatology Clinical Nurse Specialists (CNS).They can manage various skin conditions and offer support, education and treatment planning for people with chronic skin conditions. 

Advice and guidance

The Sirona community dermatology team have set up an advice and guidance service for community HCPs /AHPs and primary care practitioners across BNSSG. This service offers treatment advice and guidance for management of service users with a diagnosed chronic skin condition which is not being effectively managed and specialist dermatology input may be of benefit. (Dermatology Advice & Guidance  may be more appropriate for new or undiagnosed patients.)

Exclusions

Please note, the community service are unable to accept referrals for the following groups of patients:

• Acne vulgaris and people likely to require Roaccutane acne treatment - see Acne vulgaris page.
• Suspected skin cancers and pigmented lesions - see Skin - USC (2WW) page.
• Warts and verrucas (they can give advice and guidance) - see Warts and Verrucas page.
• Benign skin lesions that are subject to BNSSG ICB funding policies - see Benign Skin Lesions page.
• Fast-growing lesions on lower legs
• Scabies that has not already been treated as per BNSSG guidance - see Scabies page. (They will accept scabies referrals if these treatments have been tried and there has been treatment failure as this likely denotes a diagnostic query). 

Referrals on to Secondary Care

For patients who need onward referral to dermatology in secondary care, the community team can arrange this.

However, they cannot arrange onward referral to other secondary care clinics if this is required such as allergy clinics, gastroenterology, rheumatology, plastics, etc. These patients will need to be referred by their GP as necessary.

FAQs

The specific frequently asked questions below may also be helpful:

• Will they accept referrals for cosmetic treatments such as melasma, vitiligo? Yes, if the diagnosis is uncertain and they can refer on for light therapy. If the diagnosis is clear, the referral should go direct to secondary care for light therapy as they are unable to expedite them. 
• Will they accept referrals for nail conditions e.g fungal nail infections, nail dystrophy? Yes, for diagnosis purposes.
• Will they accept referrals for hair conditions such as alopecia areata, alopecia totalis, male or female pattern baldness, hirsuitism, telogen efluvium? Yes for diagnostic reasons and for further advice.
• Will they accept referrals for BCCs? No. See Basal Cell Carcinoma page.
• Will they accept referrals for diagnosis and treatment of Bowen's disease? Yes. See Bowens Disease page.
• Will they accept referrals for hidradenitis suppuritiva? Yes. Stage 1 and 2 disease. See the Hidradenitis Suppurativa page for details.
• Will they accept referrrals for patch testing? No, referrals should be to secondary care.
• Will they accept referrals for mole surveillance? No. See Mole Mapping/Surveillance page.
• Are they able to access phototherapy directly if needed? Yes. They can refer on to secondary care for this if appropriate.
• Will they accept referrals for male and female genetalia skin disorders? Yes, for diagnosis/ treatment/advice.

Referral

You can access this service via the following routes using their Referral Form if possible (not mandatory):

• eRS - routine only (although waiting times are usually less than for equivalent secondary care services)
• EMIS Managed Referrals
• Email:  sirona.dermatology@nhs.net 
• Telephone: 0117 944 9782 / 0117 944 9783 Monday to Friday 0800-1700hrs.

Please see the Sirona website for further details

For referral criteria and exclusions please see the Referrer Guide.

A patient leaflet regarding referral is available.

Patient Initiated Follow Up

Once seen/ reviewed remotely, patients may be put on patient initiated follow up (PIFU) with a timescale advised at the discretion of the assessing clinician. Patients can initiate an appointment directly during this set period, however, appointments cannot be offered on an urgent basis. At the end of the PIFU period, if a patient has not accessed the service, they will be discharged back to the care of their own GP. This will have been discussed with the patient at the beginning of their community pathway.

Patients who are under PIFU but require urgent treatment will be advised to see their own GP to allow timely assessment and treatment advice with the aim of reducing the risk of worsening symptoms or rapid deterioration eg. acute skin infection.  If urgent advice is still required following this assessment, please consider using secondary care Dermatology advice & guidance. 

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.