Can teledermatology meet the needs of the remote and rural population?

The Outer Hebrides is an archipelago of islands, 50 miles off the west coast of Scotland and has a total population of 28 000 (Scottish Government, 2020). Life in the Outer Hebrides can be challenging, especially regarding health service provision. With extreme weather conditions causing regular travel disruption, relying purely on visiting specialists is neither a dependable nor cost-effective answer. Geographical boundaries and the availability of consultant dermatologists have always been prevalent issues, especially in relation to providing equity of service to people living in the islands.

For the past 20 years, an experienced consultant dermatologist visited regularly from a mainland hospital, as part of a service link agreement, to carry out clinics once every 2 months. This was bolstered by a local GP with a special interest (dermatology), providing support and a half day clinic on the interim month. Some services were provided ‘off-island’, which meant considerable travel and inconvenience for the patients, with this 200-mile round journey costing the health-board £300 a time. The consultant dermatologist was the clinical lead for the Western Isles service and due to the extreme stresses on his time was not always able to provide ‘between clinics’ support or advice. With this level of service, 55% of all ‘urgent’ referrals were routinely breaching guideline timescales.