Dermatology is a medical speciality of enormous significance, but historically one that has been marginalised within medical school education in the UK. The skin is our largest organ with more than a thousand diagnoses. More attention needs to be paid to preparing doctors for the challenges that patients suffering from skin conditions face.
Delay in diagnosis and treatment, and an underestimation of the psychosocial and economic burden of skin disease, are only a few of the consequences of an underinvestment in dermatology. Alarming trends to outsource dermatology entirely to the community, leaving hospital inpatients deprived of expertise, pose further challenges.
Skin conditions have been subject to prescribing restrictions with an expectation of self-care. This has often been misinterpreted as self-funding, neglecting the fact that conditions such as eczema, psoriasis and acne are long-term conditions, which should be on par with others including hypertension or heart disease.
Patients usually rate the psychological impact of skin disease far higher than, for example, having diabetes.
Long waiting times for skincare appointments
Waiting times for an appointment in secondary care are in many areas beyond the 18-week referral-to-treatment target the government has set, largely because priority has to be given to suspected skin cancer cases. Patients face the problem of either not being given a prompt diagnosis or, if treatment options in primary care are exhausted, they do not get timely access to secondary care. Patient experience tells us that healthcare provision is in crisis, but what are the solutions?
With budget cuts across health and social care, efficiency measures have been introduced, which have promised improvements in care, but often are compromised by the lack of advances in technology. Our computer systems are not “talking to each other” and we have not quite yet reinstated the good old “clinician-to-clinician chat” to improve patient pathways and flow.
Initiatives such as Advice and Guidance have improved matters, particularly where teledermatology for skin conditions has been embraced at the same time, but it is not a quick solution for an ever-growing demand.
Incidents of skin disease set to rise
Workforce implications need to be more thoroughly considered with additional investment, as well as embracing multi-professional learning, provided by the Primary Care Dermatology Society, for example, to benefit patients.
The future will pose even more challenges with populations living longer and environmental changes impacting on individuals’ health. We will, inevitably, face a greater burden of disease overall. The incidence of skin cancer has significantly increased and is anticipated to continue to do so if we do not encourage behaviour change through public health initiatives when it comes to excessive exposure to sunlight.
Community-based dermatology clinics are able to support primary care in the management of skin disease, which is estimated at approximately a quarter of the current workload in general practice, but there is great variation in its application.
Getting It Right First Time, the NHS improvement programme, is being employed in some places to ensure patients are seen at the right time in the right place by the right person, but there is a lack of consistency across dermatology service provision.
What can policymakers do to help?
People with skin disease deserve better. We need to increase dermatology education in medical school, in GP and other primary care healthcare professional training. More emphasis needs to be paid on the psychosocial and economic burden by recognising many skin conditions are long term and need to be managed as such by ensuring access to appropriate treatments and monitoring of associated comorbidities.
None of this can be done without sufficient investment in the workforce and technology. It is time for policymakers to raise the bar to improve outcomes for patients suffering from skin disease, providing them with better quality of life, better mental health and increased longevity. A better experience of healthcare without variation and inequalities, a better NHS.
