“To go through school, not seeing a specialist, not having any specialist medication and just not knowing what’s wrong with you but your GP won’t refer you – it was really hard in my social life, on my confidence and it’s affected me.” Alice
Delays in initial diagnosis One of the barriers to receiving a swift diagnosis and referral to specialist care is limited awareness of eczema and psoriasis in primary care. GIRFT states that GPs will often receive only one or two weeks training in dermatology throughout five years of medical school; this means that GPs, as well as nurses and allied health professionals, may work with limited specialist knowledge when diagnosing eczema or psoriasis and refer patients onto specialist care. 13 A recent report involving engagement with healthcare professionals found that insufficient training among GPs has caused inaccurate assessments of disease severity and delays in referring patients to secondary care. 2 One patient survey has found that: • Almost half of patients were required to see their GP or nurse between two to four times before receiving an eczema diagnosis. • Almost one in ten people with severe eczema attend more than ten primary care appointments before being diagnosed. 4 Another study said that between 25% to 44% of psoriasis patients have moderate to severe disease and would likely benefit from access to specialist care and treatment. However, the same study found only 18% of patients were referred, suggesting patients could be experiencing barriers in primary care and failing to access treatment that may limit their disease progression. 34 Psychological and financial burdens are other likely impacts on a patient when experiencing delays to secondary referral. There are also specific impacts on children including under-achieving at school, strain on relationships with peers and their families all contributing to lowering self-esteem and increased isolation. 35
“I repeatedly went back to the GP with severe symptoms, but was continually prescribed topical ointments and creams, personally costing a significant amount of money.” Alice
“I feel like GPs can only do so much and when I went there, the GP once said I’m so sorry, but I just can’t help you. I don’t have enough expertise in this department.” Chloe
Given the varied nature of the symptoms of inflammatory skin conditions, and the implications for treatment, identifying the severity of the disease is essential. The resources and educational materials available to healthcare professionals should be strengthened in primary care so that they can appropriately manage patients with long-term inflammatory skin conditions and refer them onwards where appropriate. This includes specific materials for the management of children and adolescents who can face specific societal pressures during their formative years. Community pharmacists, for example, can be the first point of contact for some people and should be aware of the ‘red flags’ that indicate the need for a referral. Collaborative working between dermatologists and pharmacists is supported by British Association of Dermatologists and the Royal Pharmaceutical Society, 36 and, GIRFT has recommended that undergraduate dermatology training for pharmacists is improved so that community pharmacists are able to manage common skin conditions in line with current evidence-based dermatology national guidelines. 13
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FROM NATIONAL GUIDANCE TO LOCAL ACTION
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