The service manages and runs Dermatology Step-up Clinics to provide enough capacity to service all non-two-week-wait dermatology patients. The expected pathway for a given patient would begin with an appointment with the patients GP. If the patient's GP believes the further treatment of the patient should be continued at the step-up clinic, GPs may do a referral into the Dermatology Step-up Clinic Service.

The dermatology service provider operating within Surrey Downs is delivering a robust, patient-focused model of care that meets all key evaluation criteria satisfactorily. Through innovative service design, strategic investment, and collaborative working, the provider is achieving meaningful outcomes across quality, value, integration, access, and social impact. The dermatology clinic model developed collaboratively by the Commissioner and Community Providers, has significantly enhanced service delivery. Led by GP Champions and hosted in community settings, this model improves local access to dermatology expertise and ensures patients are triaged effectively. It also strengthens the clinical capabilities of primary care teams by reducing unnecessary referrals to secondary care. This results in more timely, appropriate care and a better overall patient experience. Dermatology waiting times in the UK vary, but can be significant, with some patients facing waits of several months or even over a year for appointments and treatment. The average time to start treatment following a GP referral is 21 weeks. However, 10% of patients wait 63 weeks or more. Some trusts report average waits of 17 weeks for treatment following an initial outpatient appointment. Dermatology referrals have shown a consistent year-on-year increase, with a forecast of an 8% growth in dermatology activity. The Step-Up Clinic approach allows benign and low-risk conditions to be managed locally, freeing up hospital resources for complex cases. This model supports value-based healthcare, reduces secondary care costs, and aligns services with population health priorities. The clinics are fully embedded within the community and multidisciplinary teams-including GPs with dermatology expertise, consultants and nurses work together to streamline care pathways. By delivering care closer to home, the model reduces travel-related carbon emissions and supports the NHS's broader sustainability goals. Each Step-Up Clinic is designed to deliver a minimum of three hours of face-to-face consultations and one hour of virtual consultations per session, with capacity to see up to 16 patients. This flexible model ensures faster access to care, reduces travel time, and improves convenience for patients. Compared to longer waits in secondary care, patients are typically seen within weeks, helping to address health inequalities and improve outcomes for underserved populations. The clinic ensures fair access to dermatology services for diverse populations and patients are seen in familiar, community-based settings, which fosters trust, strengthens engagement, and supports continuity of care. By offering care closer to home, the clinic reduces travel costs, time off work, and logistical challenges (making it easier for patients to attend and complete treatment) and manage social conditions sometimes experienced by patients with skin conditions. The service also reduces unnecessary hospital referrals, alleviating pressure on secondary care and contributing to a more sustainable, responsive healthcare system. The approximate lifetime value of the contract will be £250,000 over the 2 year term, from 1st April 2024 until 31st March 2026.