The three existing referral channels in e-RS can all support teledermatology by allowing attachment of images to advice requests and referrals, although only the enhanced A&G supports two-way dialogue and interim advice

1. Advice and Referral (Enhanced Advice and Guidance) developed in 2021 by enhancement of the existing e-RS A&G functionality, allowing streamlined conversion of A&G requests to referral if clinically indicated. Enhanced A&G allows the Dermatologist to provide an optional interim advice plan when converting the A&G to a referral, supporting the GP team to optimise primary care management while the patient waits for their appointment.

2. Referral Assessment Services (RAS) allow Dermatologists to triage faster diagnosis (2WW) skin cancer referrals or non-2WW referrals to decide whether a patient needs a dermatology appointment, a diagnostic test, or management with specialist advice in the community.

3. Directly bookable services allow patient to choose and book into clinics directly before the Dermatology team see the referral information +/- images. Dermatologists can triage after the patient has booked an appointment, and if appropriate return the referral with advice. These services are suitable for services where the number of referrals requiring return with advice (rejection) is low.

Dermatology departments and Integrated Care Systems across England can utilise different referral channels for their services depending on local and regional requirements. Only Enhanced A&G and RAS services support Specialist Advice which is a key focus of NHS England Outpatient Recovery and Transformation.