Why referral pressure starts upstream
Most referrals begin with a difficult decision made under uncertainty
Without meaningful feedback, decision thresholds drift over time — increasing variation and pressure downstream
Expected outcomes
What changes
Over the course of a pilot, you should expect to see measurable changes in system performance.
→ At the point of decision
Unnecessary referrals reduce, while high-risk lesions are escalated more consistently.
→ Across clinicians
Variation reduces, with more consistent decision thresholds.
→ Across the pathway
More patients are managed at first contact, and cancer conversion rates increase.
→ Over time
Decision accuracy improves in a measurable and auditable way.
Why decisions don’t improve — and how DermCAP changes that
- In primary care, decisions are made under uncertainty, and the safe default is often to refer “just in case”.
- With low volume of cases and limited feedback, clinicians cannot reliably adjust their referral thresholds to more accurately reflect actual risk over time.
- This is not primarily a knowledge problem. It is a feedback problem.
- DermCAP addresses this by increasing supervised case volume, linking decisions to real outcomes, and providing structured feedback over time
Within each practice:
- Dedicated “spot clinics” concentrate skin lesion cases
- Each clinical decision is recorded at the point of first contact
- Outcomes are tracked and linked back to those decisions
- Decisions are reviewed against outcomes, with structured supervision and feedback driving clinician calibration
- Structured learning supports decision thresholds and safety, and is reinforced through real decisions and outcomes
- Clinicians apply this immediately in subsequent clinics, strengthening decision quality over time
DermCAP operates within defined clinical and governance boundaries.
- Clinical responsibility remains with the GP
- Existing referral pathways are unchanged
- Decisions are supported by clear escalation thresholds
- Outcomes are tracked for both referred and non-referred lesions
- No patient-identifiable data leaves the practice
Using your existing system data:
- Referral rates
- 2WW activity
- Cancer conversion rates
Alongside decision-level tracking within DermCAP.
The pilot allows you to test this approach using your own data, within your existing system
A typical DermCAP pilot is a structured, time-limited programme designed to test this approach in real clinical settings.
- 3–5 practices
- 1 clinician per practice
- 13 months (including an initial calibration phase)
- Protected clinical time for participating clinicians
- Minimal admin support (~30 minutes per month)
- Access to referral and outcome data
Calibration is the process of gradually aligning clinical judgement with real-world outcomes over time. In skin lesion assessment, many decisions are made under uncertainty.
Without regular exposure, feedback, and outcome tracking, clinicians can struggle to adjust referral thresholds accurately over time
This can lead to:
• overly risk-averse decision-making, with unnecessary referrals
• or overconfidence, with important lesions missed
DermCAP supports calibration by:
• increasing concentrated exposure to skin lesion cases
• linking decisions to real outcomes
• providing structured supervision and feedback
• reinforcing learning through real clinical practice
The aim is not perfect certainty.
The aim is safer, more consistent decision-making that becomes progressively better aligned with real clinical risk over time
The pilot is designed to test this approach safely within your existing system.
If it demonstrates value:
→ Continue and scale
If it does not:
→ Stop, with no disruption to existing pathways
DermCAP provides a structured way to test and improve decision-making — using your own clinicians, your own patients, and your own data.
Following evaluation, systems can decide whether to continue, expand, or conclude the programme based on local outcomes and priorities
Next step
Assess whether DermCAP fits your system.