Smile for the TV doctor Dermatologists in Wales will test remote video consultations in a bid to cut wa iting lists

FROM JANUARY, consultant dermatologist Keith Freeman will be seeing his patients on television - through a video link-up that he says will save him 12 hours a week that he now spends in travelling. He hopes the change will put an end to his 15-mon th waiting list.

Patients, rather than travelling from remote areas of Wales to be seen at a hospital, will be examined by a camcorder operated by a GP in their local surgery. For the first time, patient, GP and consultant will all be present at examination.

Eight GP practices in Powys, covering 45,000 patients, are taking part in the current Tele-Education And Medicine project (TEAM). Apart from testing remote diagnosis, TEAM will also deliver training to primary healthcare staff in each practice. Each surgery will have a multi-media computer, costing about £4,000. The screen will have a video picture in the top right corner where participants can see each other as they talk over a sound link.

High-definition images of the skin ailments, taken by a Sharp video camera, will be displayed in another screen window, and there will be a "chalkboard" for both doctors to record their comments. The images can be magnified and rotated.

TEAM is pioneered by the Institute for Health Informatics at the University of Wales, Aberystwyth, and has been set up with help from BT which installed the digital links needed to transmit the video images, and from IBM, the computer company, which developed the software. Project leader Stewart Low said dermatology was selected for the test because it is so visual. "We are satisfied that the subtleties of shape and colour can be captured and transmitted."

Dermatologist Keith Freeman is based in Carmarthen and holds clinics at the Bronglais Hospital in Aberystwyth. He estimated that the saving of 12 hours a week now spent travelling will enable him to clear his 15-month waiting list in a few months. In thepilot scheme, patients will first have the video consultation, then see Mr Freeman about five days later to confirm the diagnosis. "This will test the technology and validity of the system, with each patient, in effect, acting as their own control," said Mr Low.

No treatment will be prescribed on the basis of the video examination during the test. When the scheme goes live, patients will be given a choice of a video consultation or a hospital appointment. Doctors in other specialities, including cardiology, ear,nose and throat, ophthalmology and psychiatry, are queuing up to become consultants by video, and there is pressure from other GPs in Powys to join the scheme. Terminals have been installed for the £150,000 test and two people have been trained in each practice. They will train their colleagues, with further on-line training also available from the Powys Family Health Services Authority (FHSA).

TEAM is working with Merck, Sharpe Dome, the drugs company, the School of Nursing in Swansea, and the Department of General Practice at the University of Wales to develop training packages. Medical staff will be able to study alone or use the video link to join their peers in classes and tutorials. Gwyn Phillips, the chief executive of Powys FHSA, said the use of video links has the potential not only to reduce waiting lists but also to make health budgets go further. The GP practices in Powys each have10 to 15 staff who need regular training to keep skills up to date.

"It is very expensive to get interns, and it puts a strain on the system if a member of staff is away on a training course," he said.

TEAM has been granted ethical approval for video consulting, although, in fact, Mr Low said it was not clear if that approval was required because existing medical regulations do not encompass such methods of treatment. He said the project could raise other issues the Department of Health "has not even begun to think about" - for example, with video clinics, patients will be able to consult doctors anywhere in the UK.