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By enabling consultant dermatologists to advise GPs before referral, patients not needing urgent review could be removed from the ‘two week wait’ pathway, freeing time to focus on urgent cases.

The teledermatology pathway is a great example of the clinical transformation that can be achieved by primary and secondary care working together…Most importantly, there are considerable benefits to patients in getting an accurate prompt diagnosis, reducing both anxious waits and unnecessary hospital visits.

Peter Holloway, Chair, Primary Care Group, East of England Cancer Alliance


Outpatient services were impacted heavily by the pandemic, with patients themselves delaying making GP appointments. As restrictions began to lift and appointments increase, the Ipswich Hospital Dermatology Service was experiencing significant pressure on the 2WW pathway due to the sheer volume of cases.

Of the 10,000 urgent referrals reviewed by consultants in person, only 40% were subsequently kept on the 2WW pathway. The remaining 60% were reduced in severity to routine referrals. Finding a way to separate these groups ahead of hospital attendance would therefore help to identify the more urgent cases.

They asked the Vantage team to develop a robust solution that would enable earlier triage, keep the final referral decision with the GP and stay compliant with the Cancer Waiting Times Guidance.


To ensure the solution met the national requirements for triaging 2WW cases, the team worked in close collaboration with the CCG’s Teledermatology Steering Group, including a GP, a lead consultant dermatologist, operational and IT staff and transformation lead to develop a new triage process, enabled by the integration of Rego with eRS:

  • GPs making 2WW referrals on the eRS system can now upload high-quality images of lesions for review by consultant dermatologists using Rego;
  • Once reviewed, any suggestion to downgrade a case to a routine referral instantly alerts the relevant GP, who can then decide to accept or reject the advice;
  • Cases which are triaged for a 2WW appointment are automatically booked in to the next available appointment at ESNEFT. If no response is received by the GP within 7 days, the patient would remain on the 2WW pathway.


The impact is clear. From January to May 2021, 93% of the 96 cases were triaged in one day and 50% of the total number were downgraded to either a routine referral or not requiring hospital treatment.

A survey found that 78% of respondents felt the system supported earlier detection and intervention for previously undetected cancerous lesions.

As well as reducing the need to travel to an appointment, this new process has reduced patient anxiety as they get a decision sooner without needing to make repeat calls to their GP.

Since going live, the team has helped to streamline the 2WW pathway further by auto-populating the correct eRS service for GPs.

Feedback & testimonials

  • “2WWs have been picked up quite a few times and urgent referrals requested”
  • “It is perfect for the lesions that can be treated in primary care as the advice is very specific. It also helps when I’m unsure if a lesion needs a 2WW or urgent referral. I am extremely grateful to have Rego at my fingertips!”
  • “Have found this service extremely helpful and prompt. We really recommend this and would like to continue with it on an ongoing basis.”
  • “It provides a quick response and reassurance to patients who would have otherwise waited to be seen in clinic.”
  • “I have been really grateful for this excellent service during the pandemic and patients really are pleased with quick response times.”