“It is a serious concern that there appears to be an ‘inverse training law’ in operation in dermatology, whereby in the area which is most routinely seen by GPs, the amount of training is the least.”  The British Association of Dermatologists

  • Research shows nearly a quarter of the population have sought GP advice on skin matters in England and Wales,[1],[2] yet some doctors have received as little as five days of dermatological training[3]
  • GPs in the UK handle around 13 million appointments about skin conditions every year,1 but only have 650 dermatology consultants to advise and support them1
  • Report calls for improved dermatological training and support in primary care, and for people with psoriasis to be offered regular reviews, at least annually

Today, Wednesday 3 May 2017, the Patients Association, in partnership with LEO Pharma, released a report highlighting the lack of dermatological training and support available for GPs, and the resultant disconnect between the care the 2 million people living with psoriasis in the UK[4] and Ireland[5] need, and that which they currently receive.

Despite the World Health Organisation (WHO) recognising psoriasis as an area of focus,[6] and recent advancement in treatments, the PSO What? Report – led by The Patients Association in collaboration with an expert Taskforce of healthcare professionals, patients and charities – highlights a pervading lack of undergraduate dermatology training,3 a chronic shortage of dermatologists,1 and regional inconsistencies in the availability of secondary care consultants.1 Katherine Murphy, Chief Executive of the Patients Association, said: This new report shines a light on the shortcomings of dermatological training and staffing, which inevitably give rise to sub-optimal psoriasis care. It is essential these issues are addressed if we are to improve patient outcomes, and reduce the burden of the associated comorbidities currently weighing on individuals, health services, the economy, and society as a whole.”

A survey conducted as part of the PSO What? initiative highlights that a third of the people with psoriasis surveyed do not regularly visit their GP each year.[7] The report goes on to show that GPs admit to lacking in knowledge and understanding regarding the effective management of the condition.[8] This is particularly concerning given people with psoriasis are also at risk of developing other serious associated conditions,6including psoriatic arthritis,6 cardiovascular disease,[9],[10],[11],[12] inflammatory bowel disease (IBD),6 liver disease,6 complications with vision[13] and some cancers.[14]

 Katherine Murphy continues: “Vitally, the report calls for people from all walks of healthcare – from universities, to GPs, consultants, payers and policy makers – to pledge their personal and professional support to drive real change by visiting www.PSO-What.com. People with psoriasis must be offered regular reviews, at least annually, to assess the severity and impact of their condition, their response to treatment, and the wider physical and psychological factors affecting them. However, this will only prove effective if those in primary care are given the training and support required to confidently manage and treat the physical manifestations of psoriasis, as well as its associated complications andpsychological effects.”

Dr Angelika Razzaque, GPwSI Dermatology and Vice Chair of the Primary Care Dermatology Society (PCDS), comments: “Given the right access to appropriate treatments and information, most people with psoriasis can be principally managed in partnership with their GPs, nurses and pharmacists. The onus is on all primary care professionals, to continually assess how we’re treating the psoriasis itself, and to look beyond the skin at our patients’ individual needs, screening for associated complications. By regularly reviewing patients, at least once a year, we can improve outcomes as well as help to safeguard against life-limiting psoriasis complications and reduce the potential burden on the NHS later down the line.”

Even when effectively managed in primary care, up to 60% of people with psoriasis could need specialist referral at some point,[15] however given the dearth of consultant dermatologists this may not be possible1. Contrary to recommendations from the Royal College of Physicians, no region in England has enough dermatology consultants1. Dr Anthony Bewley, Consultant Dermatologist at Whipps Cross and St Bart’s NHS Trust comments, “It is essential to address the current lack of training and formal assessment of practical dermatology skills that exist in medical school curricula. Beyond that, we, as healthcare professionals, need to move away from the misconception that psoriasis is ‘just a skin condition’, and look for the best possible whole-person care for each individual. The unfortunate truth is that past failings have seen some patients simply slip through the net. The PSO What? report signals a sea-change, encouraging patients to demand more from their doctors, and to make sure that medical professionals do not undermine their experience of living with psoriasis.

To find out more visit the PSO What? website (www.PSO-What.com) and make a personal pledge to help make a difference for the nearly 2 million people living with psoriasis in the UK4 and Ireland5.

 

[1] King’s Fund. How can dermatology services meet current and future patient needs while ensuring that quality of care is not compromised and that access is equitable across the UK? Source report, 7 March 2014.

[2] Schofield JK, Grindlay D, Williams HC. Skin conditions in the UK: a health needs assessment. 2009. Centre for Evidence Based Dermatology, University of Nottingham.

[3] Primary Care Commissioning. Quality standards for dermatology. Providing the right care for people with skin conditions. July 2011. Available at: https://www.bad.org.uk/shared/get-file.ashx?itemtype=document&id=795

[4] Mental Health Foundation, Psoriasis Association. See psoriasis: look deeper. Recognising the life impact of psoriasis. 2012.

[5] Irish Skin Foundation. Securing the future for people with skin disease. Submission to Oireachtas Committee on the Future of Healthcare (Dáil Éireann). August 2016.

[6] World Health Organization. Global report on psoriasis. 2016. World Health Organization. Available at: http://apps.who.int/iris/bitstream/10665/204417/1/9789241565189_eng.pdf. Last accessed January 2017.

[7] Data on file. LEO Pharma. DERM-004 MAR 2017.

[8] Nelson PA, Barker Z, Griffiths CA, et al. ‘On the surface’: a qualitative study of GPs and patient’s perspective on psoriasis. BMC Fam Pract. 2013;14:158.

[9] Gelfand JM, Niemann AL, Shin DB, et al. Risk of myocardial infarction in patients with psoriasis. JAMA. 2016;296:1735-41.

[10] Ahlehoff O, Gislason GH, Jorgensen CH, et al. Psoriasis and risk of atrial fibrillation and ischaemic stroke: a Danish nationwide cohort study. Eur Heart J. 2012;33:2054-64.

[11] Lowes MA, Suarez-Farinas M, Kreuger JG. Immunology of psoriasis. Ann Rev Immunol. 2014;32:227-35.

[12] Langan SM, Seminara NM, Shin DB, et al. Prevalence of metabolic syndrome in patients with psoriasis: a population-based study in the United Kingdom. J Invest Dermatol.

[13] Fraga NA, Oliveira MF, Follador I, et al. Psoriasis and uveitis: a literature review. An Bras Dermatol. 2012;87:877-83.

[14] Lebwohl M. Psoriasis. Lancet. 2003;361:1197-204.

[15] National Institiue for Health and Care Excellence. Psoriasis: assessment and management. October 2012.