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Referral guidelines - Kent

GP Referral Guidelines for Kent Integrated Dermatology Service

Please contact us if you wish to clarify any particular issue with regards to a referral

Direct GP Helpline:  01732 651042

Email: kent.dermatology@nhs.net – please note that GP referrals are not accepted by email.

Kent Integrated Dermatology is able to provide a comprehensive consultant-led community dermatology service to patients referred with a skin rash or skin lesions. However, there a few exceptions to this, which have been pre-agreed with the ICB. Please see as follows:

SKIN RASH REFERRALS – WE CAN SEE AND TREAT:

We are more than happy to see patients with skin rashes or general skin problems in community dermatology clinics. Please telephone our direct GP helpline if you have any specific enquiries about referral.

MILD/MODERATE SKIN RASHES

Wherever possible mild/moderate skin rashes should be treated within practice and only referred:

  • If standard treatment fails to treat the problem
  • If there is doubt about the underlying diagnosis

PATIENTS REQUIRING SYSTEMIC TREATMENT FOR THE LONG TERM MANGEMENT OF SYSTEMIC INFLAMMATORY SKIN DISEASE WITH CICLOSPORIN, AZATHIOPRINE, CYCLOSPHOSPHAMIDE, ALTRETINOIN AND BIOLOGICS

PATIENTS WITH LIFE-THREATENING SEVERE INFLAMMATORY SKIN DISEASE – MARK REFERRALS AS ‘URGENT’

  • Generalised erythroderma (>70% body surface area)
  • Severe drug reactions
  • Severe pustular psoriasis
  • Severe bullous pemphigoid (>30 blisters)

PHOTOTHERAPY

  • KIMS Hospital, Maidstone
  • Borough Green Dermatology Unit

SKIN RASH EXCEPTIONS – TO BE MANAGED IN PRIMARY CARE:

 Examples of skin rashes that should be routinely managed in primary care include the following:

  • Mild/moderate acne not requiring Roaccutane
  • Mild/moderate childhood atopic eczema
  • Mild discoid eczema, xerosis, or generalised pruritus
  • Plaque psoriasis confined to discrete areas
  • Recurrent bacterial infections/tinea including pityriasis versiculor
  • Botulinum Toxin Therapy for non-axillary Hyperhidrosis
  • Urticaria/angioedema
  • Alopecia areata (always refer if there is diagnostic doubt or if scarring is present)
  • Androgenic alopecia
  • Hirsuitism
  • Vitiligo
  • Melasma/Cholasma
  • Leg ulcers – we can only see patients in the community service to exclude basal cell carcinoma or Bowen’s Disease.
  • Any suspected SCC should be referred urgently on 2-week proforma.

SKIN LESION REFERRALS – WE CAN SEE AND TREAT:

We are happy to see patient with skin lesions, provided that any of the following conditions apply:

  • Skin lesions where there is diagnostic doubt and referral is warranted to exclude a skin cancer or underlying inflammatory process
  • High or Low risk Basal Cell Carcinomas: including on the face, trunk, and limbs
  • Benign skin lesions that cause severe symptoms interfering with quality of life. Examples would include:
  • a recurrent discharging cyst
  • recurrent bleeding from a vascular angioma
  • recurrent infection/bleeding from an irritated seborrhoeic keratoses

URGENT TWO-WEEK SKIN CANCER REFERRALS

  • Any patients with suspected Squamous Cell Carcinoma (SCC) or Malignant Melanoma (MM) should be referred directly to West Kent Dermatology via e-RS and directly booked into an appointment depending on preferred clinic location. Referrals are made using the standard 2-week proforma forms. If we receive a referral in error or we feel that the patient may have a SCC or MM, we will automatically upgrade the referral to the two-week rule pathway. If this is considered necessary, we will notify you on the same day and will also let the patient know when they will be seen in the dermatology service.

Any referral letter must state that referral is warranted because of diagnostic doubt or medical symptoms. Under these circumstances, we can accept and treat patients within Kent Integrated Dermatology.

SKIN LESION EXCEPTIONS:

BENIGN ASYMPTOMATIC SKIN LESIONS AND LOW PRIORITY PROCEDURES

Asymptomatic benign lesions should be considered cosmetic and the patient either advised that treatment is not routinely available via the NHS or an application should be made to the ICB “Exceptions Panel”. In addition, there is a list of ‘Low Priority Procedures’ that would not normally attract NHS funding because of limited resources:

Dermatology ‘Low Priority’ Procedures

  • Acne Scarring
  • Chemical Peels
  • Dermabrasion of Skin
  • Electrolysis for Hair Removal
  • Hair Transplant/Replacement
  • Hirsutism Treatments
  • Laser Therapy/Laser Treatment for Aesthetic Reasons
  • Laser Tattoo Removal
  • Removal of Benign Skin Lesions (Includes: papillomas, seborrhoeic keratosis, lipomas, and sebaceous cysts)
  • Skin Grafts for Scars
  • Skin Resurfacing Techniques
  • Viral Warts – surgical removal is not routinely funded (management should be in primary care)
  • Cysts & Lipomas – to be redirected to Local Enhanced Service

We are more than happy to see patients for treatment if funding has been approved by the ICB “Exceptions Panel”.