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Psoriasis: What can GPs do to deliver optimal care?

A new report has highlighted a severe lack of dermatology training and support within primary care. Dr Angelika Razzaque outlines the report's findings and what they mean for GPs.

A new report from the Patients Association, in partnership with LEO Pharma, has highlighted the severe lack of dermatology training1 and specialist support2 available for GPs.

Research shows that nearly a quarter of the population have sought GP advice on skin matters in England and Wales,2,3 yet some doctors have received just five days of dermatological training.1 There are only 650 dermatology consultants nationally to support them.2

PSO What?

The PSO What? initiative is a partnership programme led by The Patients Association and LEO Pharma, in collaboration with the expert PSO What? Taskforce. The PSO What? report highlights the need for better education and understanding surrounding the burden psoriasis places on individuals.

This article was initiated and funded by Leo Pharma for GP Connect

Demand for dermatology expertise 

Psoriasis is one of several dermatological conditions where patient outcomes may be compromised by a lack of knowledge within primary care.

This condition affects over 1.8m people in the UK4 and it is essential to ensure tailored and holistic care to effectively manage the principal psoriasis symptoms, and also to reduce the risk of associated comorbidities.

The PSO What? Report takes a positive step forward in this direction. Developed in collaboration with an expert taskforce of healthcare professionals, patients and charities – of which I am proud to be included - the report highlights that while GPs in the UK can handle around 13m appointments about skin conditions every year,2 no region in England has enough dermatology consultants when compared with recommendations from the Royal College of Physicians.2

Psoriasis needs higher prioritisation on health agendas, and stakeholders must respond by addressing the lack of practical dermatological training and formal assessment on educational curricula.

Beyond this, we as GPs should move away from the misconception that psoriasis is ‘just a skin condition’, and instead look for the best possible whole-person care for each individual.

Call for better patient care

A third of psoriasis patients surveyed as part of the PSO What? report do not regularly visit their GP each year.5 This is particularly concerning given people with psoriasis can also be at risk of developing other serious comorbidities6 including psoriatic arthritis,6 cardiovascular disease,7,8,9 metabolic syndrome,10 inflammatory bowel disease,6 complications with vision11 and some cancers.12

Aside from the physical aspects, the mental health of psoriasis patients should be taken into account. More than 10,000 diagnoses of depression and over 7,000 diagnoses of anxiety in the UK are attributable to psoriasis each year.13

General practice is a specialism of its own; our unique role in assessing the whole patient and addressing multiple comorbid conditions means that we are best placed to anticipate, prevent and manage associated conditions so that the broader burden of psoriasis can be reduced.

Given the right access to appropriate treatments and information, most people with psoriasis can be principally managed in partnership with GPs, nurses and pharmacists. By better educating GPs, we can ensure that appropriate patients are referred onto secondary care and primary care clinicians are confident in  psoriasis diagnosis and treatment decision-making. 

By reviewing our patients regularly, at least once a year, we have the opportunity to improve outcomes as well as helping to reduce life-limiting psoriasis complications and the potential burden on the NHS down the line.

PSO What? can you do to help?

The report calls for people from all walks of healthcare – from universities, to GPs, consultants, payers and policymakers - to pledge their personal and professional support to drive real change by visiting www.PSO-What.com.

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 and psychological effects.

To read the report and to pledge your support visit www.PSO-What.com.

  • Dr Angelika Razzaque is a GPwSI in dermatology and vice chair of the Primary Care Dermatology Society (PCDS).

References

  1. Primary Care Commissioning. Quality standards for dermatology. Providing the right care for people with skin conditions. July 2011. 
  2. The 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.
  3. Schofield JK, Grindlay D, Williams HC. Skin conditions in the UK: a health needs assessment. 2009. Centre for Evidence Based Dermatology, University of Nottingham
  4. Mental Health Foundation, Psoriasis Association. See psoriasis: look deeper. Recognising the life impact of psoriasis. 2012.
  5. Data on file. LEO Pharma. DERM-004 MAR 2017
  6. World Health Organisation. Global report on psoriasis. 2016. World Health Organisation.
  7. Gelfand JM, Niemann AL, Shin DB, et al. Risk of myocardial infarction in patients with psoriasis. JAMA 2006; 296: 1735-41.
  8. 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.
  9. Lowes MA, Suarez-Farinas M, Kreuger JG. Immunology of psoriasis. Ann Rev Immunol 2014; 32: 227-35.
  10. 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 2012; 132: 556-62.
  11. Fraga NA, Oliveira MF, Follador I, et al. Psoriasis and uveitis: a literature review. An Bras Dermatol 2012; 87: 877-83.
  12. Lebwohl M. Psoriasis. Lancet. 2003; 361: 1197-204.
  13. Kurd SK, Troxel B, Crits-Christoph P, Gelfand JM. The risk of depression, anxiety and suicidality in patients with psoriasis: a population-based cohort study. Arch Dermatol. 2010; 146: 891-5

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