'The virtual consultation': a COVID-19 necessity, but how does it work in practice?

As a result of the COVID-19 pandemic, routine dermatology appointments in our trust were suspended from March 2020 In response, we later introduced virtual telephone and video consultations using accuRx for new routine dermatology referrals Although supported by guidance from the British Association of Dermatologists, there is a relative lack of evidence for use of the virtual consultation (VC) in routine dermatology We therefore sought to assess its practicality and effectiveness, and reflect on the experience We undertook a review of 200 consecutive routine new patient VCs by an experienced general practitioner (GP) associate specialist during lockdown Patients were allocated a specific time for the consultation The outcomes, diagnosis, type of dermatology presentation and the use of video were recorded This was compared with 200 routine new patients seen face to face (F2F) by the same GP associate specialist in 2019 Both groups showed similar demographics (57% females, 43% males, mean age 52 1 years) Owing to the COVID-19 pandemic, average waiting times were significantly longer for VCs (33 6 weeks vs 15 5 weeks;P < 0 001) Did not attend/answer rates were very similar (VC 9 5%, F2F 10 5%) AccuRx video was used successfully for 32 5% of the patients in the VC group Of the remaining VC patients, 30 5% did not require video, 23 5% said it was not possible (no mobile phone, lack of technical experience, inappropriate location, patient refusal) and 3 5% failed The 'not possible' group were older, with a mean age of 69 2 years (P < 0 001) Dermatological presentations were similar in both groups (49% lesions, 27% inflammatory rashes, 11% other rashes, 13% miscellaneous) Fewer patients were discharged from VC after the first consultation (VC 15%, F2F 26%) and fewer referred for minor surgery (VC 22%, F2FC 27%) More VC patients were referred for routine follow-up (VC 37%, F2FC 16%) More lesions were followed-up routinely after VC (VC 39%, F2F 7%) Additionally, fewer patients with lesions were discharged after VC (VC 7%, F2F 37%) VC may have a role in the management of the long referral waiting times generated by COVID-19 in the future We conclude that VC is a satisfactory method of assessing some new routine patient referrals but does create more routine follow-up work particularly for patients with lesions VC requires a committed and organized practitioner, has advantages for the patient, a potential triage role and possible cost savings for the National Health Service We recommend seeking patient feedback concerning the VC process and analysing final diagnosis outcomes in both groups