Introduction
Skin conditions are one of the major causes of ill-health and disability in the UK and have been the second leading cause of morbidity since 1990. 1 Demand for dermatology services is significant. Skin problems account for around 13 million GP consultations and over 700,000 new referrals to secondary care each year. 4 Skin problems are the most common new presentation in primary care, representing around one in four new patient appointments. 5 However, a range of challenges currently exist across the care and treatment pathway that affect access to care for patients with inflammatory skin conditions. These include:
Increased demand Analysis completed by Carnal Farrar suggested there were over 900,000 fewer dermatology appointments due to cancelled follow ups and system disruption in the first 18 months of the COVID-19 pandemic, which is likely to have increased demand as individuals may not have been supported to manage their care effectively. 6
Significant workforce shortages NHS England’s latest workforce statistics show that there were 669 WTE consultant dermatologists working in England in June 2023. 17 According to the British Association of Dermatologist’s Staffing and Facilities Guidance for Dermatology Services, as of December 2022, there was a shortfall of 250 WTE Consultants in the UK. 7 Based on a study completed in the same year, the UK has the fewest number of consultant dermatologists per patient of all ten countries measured as part of the Global Patient Initiative to Improve Eczema Care. 18 The BAD also say the issue is not limited to consultants and more investment is needed to help train enough dermatology nurses, who are essential members of the multidisciplinary team – providing day care facilities for those with severe disease and support for families among many other roles. 8 This staffing situation has been stretched further in 2023 through persistent industrial action, with elective care planning disrupted during these periods.
Delays in referral to specialist care Many patients are facing delays in accessing specialist secondary care services where their condition could be optimally managed. Research has found that almost one in ten patients with severe eczema had to attend more than ten primary care appointments before being diagnosed. 4
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FROM NATIONAL GUIDANCE TO LOCAL ACTION
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