Table four Breakdown of the declined/returned to GP reasons (Note: all ‘return – meets clinical
threshold (no capacity)’ are offered Virtual advice where possible with a written letter sent with
declined referrals (see attached as Appendix 1.)
Declined

Return to GP Below Clinical
Threshold

Return - Meets
Clinical Threshold
(no capacity)

Return - More
Information
Required

Total
Declined/Returned

Adult (>=16)

43

21

361

142

567

Child (<16)

13

7

48

19

87

Total

56

28

409

161

654

Notes:
 Out of the 409 ‘Return – Meets clinical threshold (no capacity)’, 262 received advice through a virtual
clinic (patient not seen face to face but advice provided by Dermatologist specific to the patient’s
treatment), and a further 147, returned to their GP, were provided with general advice via letter
attached, on where to seek further assistance if their patient’s symptoms deteriorated. Additional
information is also available on the HealthPathways website.
 HealthPathways is designed and written by clinicians for medical practitioners to use during a
consultation. Each pathway provides clear and concise guidance for assessing and managing a patient
with a particular symptom or condition. Pathways also include information about making referrals
and requests to services in the local health system. (It is not accessible to the general public).
I trust that this satisfies your interest in this matter.
Please note that this response, or an edited version of this response, may be published on the
Canterbury DHB website ten working days after your receipt of this response.
Yours sincerely

Carolyn Gullery
Executive Director
Planning, Funding & Decision Support

 9923 Appendix 1 – HealthPathways - Dermatology

Dear Doctor
Thank you for your referral.
Although your patient meets our usual clinical threshold to be given a new patient appointment,
there is currently no capacity to offer them one. This is due to the staffing issues in the
Dermatology Department relating to the recent resignation of 3 of the 4 dermatologists and
maternity leave. Urgent recruitment is underway to rebuild capacity again.
Where possible, we will provide virtual advice back to you with a written letter. The more
information that is provided in the referral letter the better. Please attach photographs to ERMS
referrals, as this enables us to give advice back more quickly. Patients may be asked to attend
the hospital for professional photography to assist with the virtual clinic process.
For patients who are systemically unwell, please discuss with the on-call general medicine
registrar, who can liaise with the dermatologists if required. If the patient is not systemically
unwell, but urgent advice is sought, then please contact the Dermatology department directly. In
all cases, an ERMS referral should be made and the on-call consultant will address it as soon as
possible.
Patients with funds could be encouraged to seek a private dermatology appointment, but we
realise this is not possible for many.
Please also check on HealthPathways for more information, and use DermNet as a management
resource and consider GP to GP referral where appropriate.
The focus is to offer care for patients with severe dermatological conditions across Canterbury.
Thank you for your understanding in this difficult situation.
Please feel free to contact me with any questions about this.
Yours sincerely
David Smyth
Chief of Medicine
(Electronically checked and approved)