Virtual complex clinic for dermatology proves a success in first 18 months

A new way of supporting patients with skin conditions that lead to mental health issues is proving a success in its first 18 months.

It all came about when our dermatology service linked up with Dr Janet Angus, a consultant dermatologist at North Bristol NHS Trust and leading figure in the specialty, to set up a virtual forum for dermatology and mental health clinicians to come together to plan treatment for individual patients.

Janet runs a complex clinic that integrates physical and mental health. It’s a tertiary service open to patients across the south west – from Truro to Gloucester – but it involves travelling up to Bristol.

However the service in Somerset has for the first time made this type of care available virtually, meaning patients can get support closer to home without the need to travel.

Our dermatology services is made up of an extended team of around 30 colleagues, including 22 GPs with an extended role in dermatology.

It’s well known that people with dermatological conditions can develop mental health issues, so our consultant dermatologist, Dr Alex Anstey, contacted Janet to look at whether it would be possible to bring a variation of her successful complex service to Somerset.

“When we were developing our new dermatology service for Somerset, I got in touch with Janet, as an expert in the field, to see whether she had any advice on how we could care for those patients with mental health conditions too,” he explains.

“I knew about Janet’s clinic in Bristol, but we didn’t want our patients having to travel to Bristol for appointments, as we’ve been doing this for much of the last decade.

“These are patients who would have previously waited a long time for mental health treatment following a separate referral from their GP, but this makes it so much easier for their physical and mental health needs to be treated by the same team.

“Our patients often have complex problems, so it’s really beneficial that we can immediately set them off down the right path, where their care is discussed by a group of experts.

“Collectively we develop a management plan for each patient, with a colleague in the team taking a lead for their care – that may be the dermatologist, one of the psychiatrists, someone from talking therapies, or even Janet.

“Together, we developed the concept of a monthly multidisciplinary team meeting, which includes a consultant psychiatrist, a colleague from our talking therapies service, our lead dermatology clinical practitioner Ivona Ramoiu, who has a BA Science degree in psychology and a Masters degree in clinical psychology, myself as a consultant dermatologist, and Janet.

“Janet’s idea was that we prepare each patient’s case notes in advance for a discussion and decision on the most appropriate care and treatment for them. We also ensure that the healthcare professional who makes the referral is able to speak to any member of the multidisciplinary team.

“As it’s run online as Teams session, anyone from the team can attend, so it also serves as a really useful educational resource for our resident doctors who are training in dermatology too.

“It takes place once a month, and is run by our pathway coordinator Victoria Heathcock, who does an excellent job in pulling it all together.

“We’ve seen nine patients so far, and we believe we’re the only NHS trust in the country with this type of hub and spoke virtual clinic – certainly in the south west.”

Alex adds that having the expertise of Janet in Somerset has been a real game changer for the county and he has not seen a model like this before in the NHS.

“I’ve worked all over the UK in the NHS in lots of different departments and I’ve never come across this model of care before,” he says. “It’s great to have a national expert like Janet sharing her expertise with the Somerset dermatology team.

“From Janet’s point of view, it works well too as she’s already running a regional referral centre, but this is a great example of reaching out and connecting with consultants across her patch, and making sure that patients with complex problems have more co-ordinated care, which is closer to their home.

“It’s working well so far. From the referrals we’ve had, only a couple of patients have needed to do the traditional way of going to Bristol in person, whereas everyone else has been managed locally.

“As soon as we started running the meetings and people began dialling in to discuss these patient cases, it was immediately obvious that we were onto a winner.

“In fact, if we can run this sort of service for our small group of patients, it raises the question of what other healthcare services we could replicate it for.”

Ivona has recently taken on a leadership role within the service. “It is my honour to continue Alex’s work and take an important step forward in redefining dermatological care in Somerset, with an additional innovative behaviour modification clinic under our service,” she says.

“Skin conditions such as eczema, psoriasis, and acne are often impacted by habits, stress, and lifestyle choices, with traditional treatment alone not always enough.

“That’s why this clinic integrates behavioural science with dermatology, offering patients personalised strategies to improve adherence, reduce triggers, and achieve lasting results.”