However, in reality, due to the burdens noted above, the care pathway for many patients is fragmented, with barriers across different parts of the pathway. They include: • Almost one in ten people with severe eczema attending more than ten primary care appointments before being diagnosed. 4 • Around a third of severe eczema patients having to wait four to seven months before being seen in secondary care after referral. 4 • 56% of trusts needing regional approval before using NICE approved treatments. 13 • 98% of skin disease patients reporting that their condition affects their emotional and psychological wellbeing, yet only 18% receiving some form of psychological support. 14 • 67% of people with very active psoriasis reporting that their condition affects their working life, while 43% feel their psoriasis has limited their income and/or future earnings. 15 The NHS has recently made a series of welcome announcements on opportunities to speed up the treatment pathway for patients trying to access dermatology services, including NHS England’s Referral Optimisation Guidance for People with Skin Conditions 5 and the Getting it Right First Time (GIRFT) review into dermatology services. 13 However, there are challenges to the consistent implementation of guidance across the country due to lack of capacity; variation in approach; incompatible IT systems, particularly between primary and secondary care; and a lack of equipment and funding. 16 To support guidance adoption, a financial and resource case needs to be made to demonstrate the longer-term savings that could be achieved from implementing these considerations. An initial analysis of limited available data shows that just reducing the number of pre-referral appointments could save £1,779,660 in psoriasis and £3,948,019 in atopic eczema [see Part 3 for calculation methodology] . In practice, the total savings at the delay to referral stage, and throughout the rest of the pathway, could be much higher, particularly when considering the wider socio-economic impacts of these conditions. Expanding these initial calculations to make a comprehensive financial and resource case for the wider adoption of these guidance changes is therefore pivotal.
Other actions for consideration which may help remove persistent barriers to improved care and treatment for patients with inflammatory skin conditions are:
1 Core action to consider: Ensuring systematic national data on diagnosis, referral to specialist care and access to advanced treatment is collected. (NHS England)
2 Core action to consider: Setting a target of full implementation of NHS England guidance on referral optimisation for people with skin conditions and annually benchmarking trust uptake. (NHS England) 3 Core action to consider: Reporting on the financial costs to the NHS (direct, indirect and resource costs) created by barriers identified in this report. (National Audit Office)
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FROM NATIONAL GUIDANCE TO LOCAL ACTION
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