P16: An assessment of the experiences of general practitioners and general practitioner trainees of referrals to paediatric dermatology services

N. Fagan,¹ F. Browne,² Á. Carroll^3,4 and A.D. Irvine²

¹St. James's Hospital, Dublin, Ireland, ²Children's Health Ireland at Crumlin, Dublin, Ireland, ³National Rehabilitation Hospital, Dublin, Ireland, ⁴University College Dublin, Ireland

General practitioners (GPs) are the gatekeepers to secondary care. The UK’s All-Party Parliamentary Group on Skin report acknowledges the challenges that many GPs have with diagnosing skin disease, resulting in inappropriate referrals. In Ireland, the system is overburdened and with waiting lists upwards of 3 years for a routine appointment, delays can be experienced by those requiring specialist care. This study aimed to investigate GP and GP trainees’ experiences of referring to paediatric dermatology services, how comfortable they were with diagnosing and treating skin disease, and to explore potential interventions. A 24-item online questionnaire was distributed to participants across Ireland using a GP forum and a database of GP referrers supplied by a major national secondary care centre. Trainees were invited through their training networks. Responses were received from 162 GPs and 44 trainees (n = 206). Fewer than half of respondents had a special interest in dermatology (47%) or a postgraduate qualification (34%). The majority (54%) estimated that dermatology cases made up 10–20% of their workload. Most referred less than once a month (63%) and most frequently at the fourth or fifth visit (47%). Unsurprisingly > 95% of respondents were comfortable diagnosing and treating common skin conditions such as eczema and acne. Interestingly, many were uncomfortable diagnosing common presentations such as melanocytic naevi (68%), drug eruptions (46%), birthmarks (35%) and infantile haemangiomas (32%). Some felt uncomfortable treating common conditions such as drug eruptions (37%), psoriasis (29%) and infected eczema (19%). The most frequent reasons for referral were severe skin disease (74%), uncertain diagnosis (70%) and parental request (44%). Nearly all (95%) believed integrated care pathways would be beneficial. Most wanted more education (92%) and felt they did not receive enough training (79%). Many respondents (43%) felt they did not have access to specific paediatric dermatology resources and would use national guidelines (88%). Over half (67%) were interested in managing chronic skin disease in children. Nonmandatory open-ended questions revealed that access to teledermatology was the most desired resource (n = 22), followed by national guidelines and specialist nurses. As expected, long waiting lists was the dominating complaint. As key stakeholders it is essential that GPs feel confident managing skin disease. The majority felt they would benefit from targeted interventions. Access to teledermatology services was the most commonly requested resource. Education on common conditions would be well received and could reduce the numbers of patients referred to secondary care, increasing capacity for complex cases.

[Correction added on 22 November 2022, after first online: affiliation details of authors A. Carroll and A.D. Irvine have been updated in this version.]