Part 4 Actions to consider
This paper analyses the current treatment pathway for atopic eczema and psoriasis patients in the UK and compares this to the optimum care management pathway as set out in national guidance – highlighting the delays to diagnosis, specialist care, and access to treatment faced by these patients. However, as noted, a range of guidance and policy opportunities now exist that, if implemented, could help reduce these barriers and improve care for patients. In this context, we have identified the following actions which appropriate institutions may consider undertaking to embed these changes:
Core actions to consider 1 NHS England should consider ensuring systematic national data on diagnosis, referral to specialist care and access to advanced treatment is collected – so the full unmet need of patients living with inflammatory skin conditions can be analysed and improvements monitored. 2 NHS England should consider setting a target of full implementation of its guidance on referral optimisation for people with skin conditions locally, as well as benchmark and annually review how, and the extent to which, it is being implemented by trusts. 3 The National Audit Office should consider publishing a report on the financial costs to the system (including direct, indirect and resource costs) created by the barriers identified in this report. In particular, it should consider the delays in referral to specialist care for patients with inflammatory skin conditions and variation in access to the full range of NICE-approved treatments once under secondary care. Pathway actions to consider 4 Secondary care: NHS England should consider mandating NHS trusts to monitor and track data on outpatient appointments for adult patients with diagnosed or suspected atopic eczema and psoriasis, to monitor access to care for patients with these conditions locally. 5 Secondary care: NICE should consider formally recognising the EASI scoring system in eczema and PASI scoring system in psoriasis, so that there are nationally endorsed tools for measuring disease severity – in line with clinical practice. 6 Access to treatment: Integrated Care Systems should consider removing all barriers to NICE-approved treatments. In support of this, NHS England should encourage the implementation of best practice pathways already in place, which can be consistently applied by healthcare professionals in the area. 7 Access to treatment: All GIRFT recommendations aimed at ensuring the consistent implementation of NICE guidance should be implemented, requiring trusts to submit data that allows for regional benchmarking of treatment use and identification of unwarranted regional variation. 8 Follow up: Raising wider awareness of the need to implement NICE’s shared decision-making standards framework, and ensure SDM standards and patient partnership approaches, such as those developed by the Patients Association, should be considered as routine approaches to care, where appropriate.
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FROM NATIONAL GUIDANCE TO LOCAL ACTION
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