From National Guidance to Local Action: Improving Access to Dermatology Services
A new report from AbbVie advocates for the full implementation of government guidance that has the potential to remove barriers to care and treatment for dermatology patients and deliver system savings.
This article and the From National Guidance to Local Action: Improving Access to Dermatology Services report has been commissioned and funded by AbbVie. This article is intended for the general public.
Inflammatory skin conditions such as psoriasis or eczema cause misery for millions of Britons, impacting both mental and physical health.
They also are one of the biggest day-to-day demands on GP time. With 13 million consultations relating to a skin condition each year1, skin problems are the most common new presentation in primary care, accounting for around 1 in 4 new patients.2
Being able to access the right care at the right time is essential for those who are living with an inflammatory skin condition. But all too often, hard-pressed GPs and a lack of access to specialist care means that patients struggle to get the help they need.
Those challenges have been amplified by the COVID-19 pandemic and the continuing impact of the disruption it caused to both patients and the nation’s health systems. As a result of the pandemic, there were 900,000 fewer appointments due to cancelled follow ups and system disruption over 18 months.3 As of August 2023 there are over 434,000 patients languishing on the 18-week waiting list, almost double the number who were waiting before the pandemic, and this number is on the rise.4,5
The government has recently ensured steps are taken to respond to the challenge to patients and the healthcare system that this represents. NHS England has made a series of announcements intended to speed up the treatment pathways for patients trying to access dermatology services, including the Referral Optimisation Guidance for People with Skin Conditions and the teledermatology virtual urgent skin cancer pathway.
However, a new report commissioned and funded by biopharmaceutical company AbbVie and carried out by health policy consultancy Evoke Incisive Health, has revealed that a slow pace of adoption means that patients are still failing to access the care that they urgently need.
From National Guidance to Local Action: Improving Access to Dermatology Services identifies some of the persistent barriers that exist to dermatology patient care and sets out the difference that adopting the NHS England guidance could make. It has led to calls for more action from government to ensure that the guidance is rapidly implemented in full across England.
Kavita Sharma, Medical Lead for Dermatology from AbbVie told PoliticsHome that the new research shows that the slow pace at which trusts are adopting the new guidance means patients are continuing to struggle to access care.
“National guidance provides the starting point, but as this research points out, it is not being adopted by trusts at the pace required, means elective recovery waiting lists continue to grow,” Kavita from AbbVie tells us. “As pointed out in in the report if the guidance was adopted in full, one estimate predicts it could generate an additional 48,000 clinical hours that could support patients with inflammatory skin conditions.”6
Those additional clinical hours could potentially be transformative for those awaiting care, particularly those who are not currently fast-tracked through the healthcare system.
Laura Stevenson, Deputy Chief Executive of the Psoriasis Association, told PoliticsHome that resource constraints meant that certain patients were understandably having to be prioritised. However, she cautioned that as a result, many other patients were facing unacceptably long waiting times.
“The emphasis on prioritising people with suspected skin cancer has reduced the access to care for people with inflammatory skin conditions who are often waiting a long time for an appointment,” she explains to PoliticsHome. “We are receiving so many calls and emails regarding waiting times for dermatology and rheumatology appointments which can exceed 40 weeks and be as high as 62 weeks in some areas.”
Sammi Skelding, Deputy Chief Executive of the National Eczema Society shares Stevenson’s view that lengthy delays are causing misery for patients and resulting in missed opportunities to tackle skin conditions at an early stage.
“Eczema is a complex condition involving our immune system, genetics, environment, and skin barrier,” Skelding explains. “The current lack of services and extended waiting times to see a dermatologist can severely affect people's health and quality of life. Therefore, it is crucial we have new guidance and implement the necessary measures to address this issue.”
AbbVie’s new report shows that implementation of existing guidance could help optimise treatment pathways and end the postcode lottery which is resulting in fragmented care for patients. For instance, 56% of trusts require regional approval before using NICE-approved treatments, slowing down access to treatments that are urgently needed.7
Not only could the implementation of guidance improve outcomes for patients, but it could also deliver savings for the NHS. The report shows how just reducing the number of pre-referral appointments could save £1,779,660 in psoriasis and £3,948,019 in atopic eczema. Final savings, taking into account the whole care pathway, are likely to be much higher.8
The new report does not just describe the scale of the challenge, it also sets out some of the solutions that could help transform the care that people living with skin conditions receive. That practical approach has been welcomed by Sir Paul Beresford, former Chair of the APPG on Skin.
“The report, From National Guidance to Local Action: Improving Access to Dermatology Services is a serious consideration on providing more dermatological services better and even for less,” Sir Paul tells PoliticsHome. “Skin is the biggest organ of the human body. We don’t give it much thought unless something goes wrong. Much progress has been made over the last few years, but more can be done with the service availability the NHS already has.”
That aspiration, to speed up access to care that could improve the lives of millions, sits at the heart of the new report. Delivering that could not only benefit patients, it also potentially benefits the NHS as a whole.
Date of Preparation: December 2023
Job No: UK-IMM-230326
Please note PoliticsHome Hyperlinks/websites/tags are non-AbbVie sites and AbbVie are not responsible for content from these links
1. Allergy UK and Sanofi Genzyme, 2017. Seeing Red: Getting Under the Skin of Adult Severe Eczema
2. NHS England, 2022. Referral optimisation for people with skin conditions
3. Carnal Farrar, 2022. Creating capacity: Transforming the dermatology service
4. NHS England, 2023. Statistical Press Notice NHS referral to treatment (RTT) waiting times data, August 2023
5. NHS England, 2019. Statistical Press Notice NHS referral to treatment (RTT) waiting times data, August 2019
6. Carnal Farrar, 2022. Creating capacity: Transforming the dermatology service
7. Getting It Right First Time, 2021. Dermatology GIRFT Programme National Specialty Report
8. See Part 3 of From Guidance to Action: Unlocking Faster Access to Dermatology Services report for calculation methodology.
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