Sahar Alikhan is a GP with Extended Role in Dermatology, Leeds GP Confederation and Leeds Teaching Hospitals NHS Trust.
Urgent suspected skin cancer referrals continue to rise year on year, stretching both general practice and secondary care.1 Teledermatology has become a vital tool in managing this demand, enabling rapid triage through the submission of clinical and dermoscopic images. Yet its effectiveness hinges on more than technology. The pathway succeeds only if image quality is sufficient, systems are robust, and clinicians feel supported.
In Leeds, we have operated a skin cancer teledermatology pathway for 8 years, triaging between 250 and 400 referrals each week. Images are reviewed and patients are directed either back to their GP, to surgery, or to a face-to-face hospital appointment. Despite the efficiency of this system, audits revealed familiar frustrations including inconsistent image quality, variable access to dermatoscopes, patchy confidence in dermoscopy, and referral forms that varied from practice to practice. These issues affected triage decisions, generated additional work, and risked delays in diagnosis.
When I was appointed as Primary Care Skin Cancer Pathway Lead in October 2024, my focus was to strengthen the pathway. Over the following months, I worked with colleagues to improve skills and confidence in lesion recognition and dermoscopy. More than 100 clinicians across 14 practices attended practical, in-person training sessions. This was supported by an educational video, See It. Snap It. Send It: A Teledermatology Guide for Leeds Primary Care, which provided concise, practical advice on taking high-quality images. Presenting at citywide teaching events extended this message further, embedding good practice across primary care.
“These small but cumulative changes have translated into safer patient journeys and reduced pressure on dermatology clinics.”
We also simplified the referral process itself. In April 2025, a new urgent suspected skin cancer referral proforma was launched, jointly developed by colleagues in primary and secondary care. The updated template provided a consistent structure across the city, reducing variation between practices and cutting down the need for follow-up queries. Alongside this, a dermatoscope sustainability scheme was introduced in partnership with our integrated care board (ICB). A repair and replacement service now ensures faulty equipment is rapidly addressed, preventing disruption to patient care.
These interventions have already delivered measurable improvements. An audit comparing early 2024 with the period following implementation showed a 57% reduction in referrals with image-related issues, and a 61% drop in those affected specifically by poor image quality. GP confidence in using dermatoscopes and recognising skin cancers has also risen sharply.
The impact has been more than technical. Acting as a GP with an extended role (GPwER) allowed me to bridge the divide between primary and secondary care. Understanding the daily realities of general practice meant the training was relevant, practical, and achievable. Peer-to-peer teaching fostered trust and engagement, while a dual perspective helped smooth communication between services. These small but cumulative changes have translated into safer patient journeys and reduced pressure on dermatology clinics.
This experience highlights that improving cancer referral pathways is not simply about better technology or process redesign. It’s about empowering clinicians to use these systems with confidence and about ensuring the voices of general practice are present when pathways are created. The GPwER model provides exactly this: someone fluent in both primary and secondary care, able to translate between the two, and to implement solutions that are realistic in busy surgeries.
For commissioners and ICBs, there is a wider lesson. The success of the Leeds skin cancer pathway has rested on investing in clinical leadership at the interface of care. As demand continues to grow, GPwERs could be deployed strategically in other areas of cancer care helping to streamline referrals, reduce unnecessary workload, and keep patients firmly at the centre of pathway design.
Acknowledgements
With thanks to the Dermatology Department at Leeds Teaching Hospitals NHS Trust, Leeds GP Confederation, West Yorkshire and Harrogate Cancer Alliance, and NHS West Yorkshire Integrated Care Board for their support.
Reference
1. British Association of Dermatologists, NHS England. The two-week wait skin cancer pathway: innovative approaches to support early diagnosis of skin cancer as part of the NHS COVID-19 recovery plan. 2022. https://www.england.nhs.uk/wp-content/uploads/2022/04/B0829-suspected-skin-cancer-two-week-wait-pathway-optimisation-guidance.pdf (accessed 17 Sep 2025).
