From newstatesman.com
We urgently need more dermatology specialists and a greater focus on skin conditions
We need to talk more about psoriasis. Save for the occasional celebrity diagnosis – which only shows the tip of the iceberg – psoriasis doesn’t often hit the headlines.
Yet, 1.8 million people in the UK are affected by this condition, and the full impact, including depression, inability to work, and financial distress, is overlooked. Debilitating symptoms are often compounded by a difficult and lengthy route to diagnosis and treatment, with patients frequently deprioritised in an overburdened health system.
To understand more about psoriasis in the UK and Ireland and identify solutions to better support the patient community, the pharmaceutical company Bristol Myers Squibb (BMS) has commissioned a new report.
UK patients are facing a “dual backlog”
As we are all aware, the last few years have been challenging for healthcare systems around the world. In the UK, already thinly stretched resources were loaded with enormous pressure by the Covid-19 pandemic, inevitably creating lengthy wait times. Facing the daunting task of wading through the backlogs, the NHS is rightly prioritising the most urgent cases, such as cancer diagnoses and treatment. However, within pressurised dermatology units, psoriasis patients face a dual backlog – firstly in delays accessing support due to the pandemic, and now with other conditions taking priority.
A clear case for reform
While delays are unavoidable within the current climate, we must also acknowledge that leaving psoriasis unmanaged has an impact, and not just for patients. Loss in productivity due to absenteeism from people with psoriasis equates to almost £1.07bn per year, and if we were to reduce sickness absence in working UK adults with psoriasis by just 10 per cent, we’d see a £50m boost to the economy.
Another challenge is that one in four people in England and Wales are seen through the current primary care pathway regarding a skin, nail or hair condition every year, yet there is a need to improve training in dermatology for GPs. In terms of psoriasis, diagnosis and many effective treatments can indeed be administered within the primary care setting, but almost three quarters of patients are not offered different treatment options and 54 per cent reported not feeling included with the decision-making process for their treatment.
Timely intervention can reduce complications
Because of the lack of dermatology training among GPs, between 31 and 59 per cent of referrals to secondary care take place before a psoriasis diagnosis has even been made. There is significant variation in wait times for a first outpatient appointment in dermatology across England, ranging from 32 days to a potential delay of over 33 weeks for some psoriasis patients, according to the English Hospital Episode Statistics (HES) database. Crucial time is being lost for these patients who are at risk of developing comorbidities such as cardiovascular disease, obesity and diabetes if not adequately treated. With psoriasis, time is of the essence; once the condition is controlled, routine follow-ups may not be needed, and could even move to being fully initiated by the patient in times of need.
Considering the solutions
There are many solutions that can be introduced to assist primary care teams with diagnosing and managing psoriasis, including the use of screening tools and digital solutions such as tele-dermatology. The NHS Long Term Plan specifically mentions how technology can support specialist referrals in dermatology with photos and questionnaires, meaning some patients can be managed entirely digitally. Furthermore, artificial intelligence is becoming more and more widely used and there is ample opportunity for AI tools to be used in healthcare to improve patient outcomes, increase productivity across the system, and free up clinicians’ time.
Dr Stephanie Gallard, general practitioner with special interest for the Dermatology Integrated Clinical Assessment and Treatment Service at Liverpool University Hospital Foundation Trust, says: “The implementation of tele-dermatology services, providing the ability to triage photographic images and safely screen out the 30-50 per cent of patients with clinically benign lesions who require no further investigations is proving highly beneficial.
“Most trusts in England now utilise this pathway, which gives a decision within 72 hours and spares patients with benign lesions an anxious wait for a dermatology appointment. Saved medical resource can be directed to other clinics. The use of AI to triage images will aid this process further, with at least six trusts across the UK already using such technology.”
Additionally, supporting GPs and nurses with access to specialist advice and guidance, creating shared learning opportunities, and establishing GP champions could all help to train primary care health professionals to manage more psoriasis cases within their clinics. Training schemes for GPs, nurses and pharmacists must also include dermatology, and pharmacists should be encouraged and empowered to manage common skin conditions such as fungal infections and warts to reduce the burden on GP surgeries and free up time to deal with more serious cases. The pharmaceutical industry can support the NHS with implementing training programmes like this, and should make every effort to collaborate with healthcare services in future to help facilitate progress.
Planning for longer-term reform
The British Association of Dermatologists has long been calling for the expansion of the dermatology workforce, and the State of the Nation Psoriasis report also concludes that this is an unavoidable necessity to achieve change. However, the reality of implementing meaningful reform relies on investment in more roles and greater integration between healthcare services including primary care, dermatology and mental health. But beyond better-staffed teams, there is opportunity to drive efficiencies, and work should begin in earnest to prepare NHS staff and begin to implement processes and infrastructure for the full impact of digital technology.
Increasing the use of virtual “superclinics” is also a promising prospect for the future. These are hub-and-spoke model clinics designed to maximise the expertise of the most experienced team members to support more junior doctors and nurses with the delivery of specialised care to the highest number of patients. Such clinics, while currently few and far between, have been celebrated within the dermatology community for their efficiency, and their expansion could mean more patients are managed in an effective, timely and patient-centric way.
At Bristol Myers Squibb, we’re determined to work with stakeholders to help the complex psoriasis management landscape. We are listening to the community and trying to better understand some of the key pressures facing the NHS, dermatologists and psoriasis patients. With the launch of our report, we hope to provide support to improve the way in which psoriasis is managed in the UK.
Read the full State of the Nation Psoriasis report here.
