Improving sustainability in the Urgent Suspected Skin Cancer pathway

Improving sustainability in the Urgent Suspected Skin Cancer pathway.  

Project completed as part of Wrightington, Wigan and Leigh (WWL) Green Team Competition 2025. 

Team members:  

• Lewis Veale (Physician Associate & Skin Cancer Pathway Specialist); Dr Monica Bhushan (Consultant Dermatologist & Clinical Lead for Skin Cancer); Andrea Jones (Head of Medical Illustration); Olivia Madden (Medical Photographer); Ayesha Habib (MBChB student). 

Setting / patient group:  

Urgent Suspected Skin Cancer referrals across Wigan; community imaging hubs (Standish live; Boston House next). 

Issue:  

The number of referrals into the urgent suspected skin cancer (USSC) pathway is increasing exponentially. With an increase of around 15% in 2024-25(1), the dermatology department are on track to receive close to 5000 USSC referrals this year.  

A tele-dermatology pathway was established in 2024, but ongoing challenges were identified.  

Intervention:  

Aim: Improve accessibility of the urgent suspected skin cancer (USSC) Tele-dermatology pathway by shifting imaging appointments from the hospital to the community. 

It was recognised that the equipment and location requirements for photography clinics were standardised and overall portable, meaning there was the potential for clinics to be held away from the base at Leigh Infirmary. A set of minimum suitability criteria for alternative rooms was developed, and suitable rooms identified. 3 community locations were identified as suitable and coveringf a wide geographical area to suit the majority of patients. A community based imaging hub was piloted from July 2025.  

Outcomes: 

Impacts below are based on an average of 72 Tele-dermatology appointments per week (3,700 patients per year) seen in the USSC pathway. 

Clinical:  

• Average referral-to-appointment time reduced by 0.1 days (supporting adherence to Faster Diagnostic Standard). 
• Maintained image quality and care standards. 
• Faster and more accessible diagnoses for patients. 

Environmental: 

• Projected savings 4,501 kgCO₂e per year from reduced travel. 

Financial:  

• Avoided DNAs and cancellations but this was not quantifiable.  
• Potential long-term savings from reducing reliance on locums, projected at approximately £200,000 per year, however additional changes required. 

Social 

• Patients and carers saved travel time and expenses. 
• Higher patient satisfaction at community clinics. 
• Reduced time off work and carer burden. 
• Staff benefited from shorter commutes and car-sharing. 

Key learning point:  

Capacity and access gains come from moving diagnostics closer to patients while protecting image quality. Multi-team coordination and clear on-site wayfinding mattered. The project was supported by team and service user agreement that there was a problem, and that the changes were suitable with minimal disruption to staff workflow.