Community Dermatology Clinics – how can they help you? Your “need to know” guide on Community Dermatology Clinics

Skin concerns include rashes, moles, skin lesions, hair loss or nail changes. The first port of call is your GP surgery. Within a GP surgery, there are not only doctors but other allied health professional including practice nurses, physician associates and pharmacists.  This team are able to make an initial assessment of the symptoms you may be experiencing and take a history of when the skin concern started. 

It is important to note that as a patient, you can request to see a health professional of your choice and specify a preference on the gender of that professional. Your GP surgery will always do their best to accommodate your needs.

I would also recommend taking photos of the area of concern as skin rashes and skin lesions can change over time and these photos can be helpful at your GP appointment and for any subsequent appointments in the dermatology clinics.

In addition, some skin concerns can fluctuate in appearance meaning they could be less visible by the time you get seen so taking photos to keep record are helpful. Make sure your photos are not blurry, taken in some natural light, avoiding any casting shadows. You may be asked to send some photos in. It is useful to send a photo of the whole area affected (i.e. zoomed-out) as well as some close-up photos. You should not send any photos in of intimate areas. These areas are examined in person and with the offer of a chaperone.

It may be that your GP or other health care professional is able to offer a potential diagnosis and offer a trial of treatment – for example in the case of a rash like eczema or rosacea. Following this trial of treatment, a review is made and if things are not improving, your GP surgery will then make a referral to a community dermatology team. If your GP is not sure what the diagnosis is, a referral is made straight to the local dermatology team. 

We are very fortunate that most GPs in the UK have a local referral pathway so a patient can be seen for their skin concern at a local health care centre, rather than the hospital. In fact, most skin concerns can be dealt with in a Community Dermatology Clinic. The team is made up of qualified GPs with extended roles in Dermatology (or GPwER Derm for short!) and nurses. 

GPwERs in Dermatology are GPs that have done extra training in dermatology as well as completing their GP training (which is five years from finishing medical school). Not all GPs specialise but some who have an interest in a particular area can do courses including diplomas and work in clinics to gain more experience. Some of these locally run dermatology clinics also have Dermatology Consultants supporting the workload and can provide even more expertise, training and educational opportunities.

When you are seen in the Community Dermatology Clinic, your dermatology doctor/nurse will have reviewed the letter from your GP and detailed what treatments if any, have been tried. Often, a GPwER may re-try some of these treatments if they think this was the right treatment given by the GP but adjust the length of treatment. In addition, GPwER’s will understand nuances of the treatments and try to tweak treatment plans so that it suits your day-to-day life. 

Depending on the services local in your area, dermatology treatment options can vary. For example, treatments such as light therapy (e.g. for eczema) and Immunosuppressants (e.g. for psoriasis) can be offered by Community Dermatology Clinics if the services are available. These treatments need discussion, counselling and monitoring by the Community Dermatology Clinics (these treatments are not initiated by your own GP).

Community Dermatology Clinics also offer skin biopsies to determine the cause of a rash or skin lesion if the diagnosis is not clear. This sample is then sent to the hospital for analysis and the report is sent back to the dermatology clinic to review the results for discussion. The biopsy report can take up to six weeks.

It is important to note that if a GP or health care professional you see at your GP surgery is concerned about a mole that look worrying, then your GP surgery will refer you straight to the hospital through a rapid access two week-wait. This is to avoid delay in diagnosis if your GP feels that your skin lesion may resemble a skin cancer. This feels scary and can be a worrying time, but it is important to attend this appointment as your GP has expressed some concerns about your skin lesion. This way, you are seen and assessed much quicker.  

If you have not heard from the hospital within two weeks, it is important to ring your GP to chase up the referral. Hospitals will usually call (sometimes from an “unknown” number) or text you about seeing the hospital dermatology team. It is important to keep your phone on loud in this two week wait to ensure you get your appointment details.

Suspicious skin marks and moles are reviewed by consultants and their teams. They will also have a discussion with you about performing a skin biopsy (a small sample of the skin lesion is removed) to confirm a diagnosis. Sometimes photographs of your skin lesion can be taken by the dermatology team to monitor skin lesions and to track any changes if a biopsy is not warranted.

In summary, Community Dermatology Clinics run by GPs with extended training have offered shorter waiting times and have been more convenient for patients in comparison than waiting for a hospital appointment. Most dermatology appointments take place in buildings which are equipped with a minor surgery room (for skin biopsies) and a consultation room similar to those found in a hospital setting.