Dermatology service in Wolverhampton

We accept referrals for any of the conditions listed below:

• Moderate to Severe rashes of diagnostic uncertainty
• Advice and guidance for benign lesions of diagnostic uncertainty
• Eczema which has failed to respond to treatment in primary care
• Psoriasis which has failed to respond to treatment in primary care
• Acne Vulgaris, Rosacea and Hidradenitis Suppurativa which has failed to respond to treatment in primary care (including the prescribing of isotretinoin for moderate to severe acne)
• Chronic inflammatory dermatoses
• Premalignant skin lesions such as actinic keratosis or Bowen’s disease
• Allergic Contact Dermatitis, Occupational Contact Dermatitis and Irritant Contact Dermatitis
• Urticaria
• Nail disorders following exclusion of fungal infection (excludes pigmented lesions)
• Inflammatory scalp disorders and Alopecia
• Low-risk Basal Cell Carcinomas (BCCs) (in line with national guidance)

Exclusion criteria:

• Patients under the age of 18 years old
• Patients not registered with a Wolverhampton GP (as defined by the ICB)
• Emergency presentations
• Post-operative complications
• Trauma/complications of trauma
• Suspected connective tissue disorders
• With the exception of low-risk BCCs, all other lesions which are suspicious for cancer should be sent to the Royal Wolverhampton Trust via the Suspected Cancer Pathway and NOT sent to the Circle Community Dermatology Service
• Any condition listed within the policy for procedures of limited clinical value without prior approval of an individual funding request.

• General Dermatology Clinics
• Minor surgery (biopsies and excisions)
• Cryotherapy
• Phototherapy
• DMARDs, Retinoids and Biologics clinics
• Patch testing

Please complete the community dermatology referral form on EMIS, providing all relevant information, and send this to Circle via eRS.

Where possible, please attach high-quality images of your patient’s skin condition or lesion, to enable better triage decisions and get patients on the right pathway more quickly. We will otherwise arrange for patients to come to a teledermatology appointment where we can take our own high-quality images, ahead of clinical triage: we arrange these appointments as quickly as possible, this does lead to delays to patients’ pathways.

We hold teledermatology clinics which allow us to take high-quality images of skin lesions with dermatoscopes. These images can be uploaded to our bespoke, secure portal where our expert clinicians undertake triage. They then provide a diagnosis and treatment plan wherever possible, and share this with the community dermatology team for actioning.

If they are unable to make a diagnosis with these images, we will arrange for the patient to be seen face-to-face.

An expert clinician will triage your referral and advise on the most appropriate management plan. They aim to triage urgent referrals the same day they are received.

Triage can result in the following outcomes:

• The patient could be scheduled for investigations and/or an initial appointment within the community dermatology service.
• Referral to secondary care, for services not within the scope of the community dermatology service
• Referral to other community care services
• Returned to the GP with advice for treatment in general practice.

Patients who receive treatment within the community dermatology service will be monitored and supported throughout their pathways, until completion of treatment. Should a patient’s condition require further treatment, and/or onward referral to another allied service, this will usually be arranged through the Circle hub and should not require further input from the patient’s GP.

Circle can only accept patients who are registered with a Wolverhampton GP; and the Circle Community Dermatology Service is the only NHS dermatology service to which Wolverhampton GP-registered patients can be referred.

We urge patients to contact the clinic they’re booked with (contact details are included with appointment information) as soon as possible if they’re unable to attend their appointment. If a patient DNAs twice without contact or reason, they will usually be discharged back to their GP (unless this is considered clinically inappropriate, in which case we may contact the patient to offer a further appointment).

Patients who do not attend an appointment in secondary care will be subject to the individual provider’s DNA policy, which Circle cannot influence.

When clinically appropriate, Circle will discharge the patient back their GP with a clear discharge plan.

Some patients may be placed on a patient-initiated follow-up (PIFU) pathway if there is a risk that their skin condition may return and they may need further input from our service. This PIFU period is generally 12 months but may vary from patient to patient. If the same problem recurs within the PIFU period, the patient can contact Circle directly and we will reinstate their referral.