A new report by The Patient Association in association with LEO Pharma has highlighted the significant gap between training/support available in primary care and the needs of people living with psoriasis in the UK and Ireland.

Nearly two million people are currently living with psoriasis - a common, serious, lifelong, incurable autoimmune disease - in Great Britain and Ireland. Around 80 percent of patients have chronic plaque psoriasis, which is characterised by thickened, scaly plaques on the surface of the skin causing scaling, itching, stinging, burning and bleeding.

According to the PSO What? report, psoriasis costs the UK economy over £1.07 billion in lost productivity alone, and also represents a significant drag on health services, accounting for 5 percent of GP dermatology consultations in England and Wales.
And yet this workload is not balanced by adequate dermatology education for GPs and there is a chronic shortage of dermatologists, the report notes. GPs have little dermatology training and education and there are only 650 consultants to advise them, and provide more specialist care.

Currently there is no compulsory requirement for dermatology training within undergraduate or postgraduate curricula. In some cases, training is less than five days, despite a minimum of two weeks recommended within the 2006 dermatology curricula, distributed to all medical schools.

“It is a serious concern that there appears to be an ‘inverse training law’ in operation in dermatology, whereby in the area which is most routinely seen by GPs, the amount of training is the least,” says the The British Association of Dermatologists.

“It is important that medical professionals who are treating psoriasis are adequately trained and offer a full service (including the exploration of how each patient’s condition is affecting both their mental and physical health, and the regular review of the effectiveness of treatments) if they are to contribute towards their patients’ successful management of their conditions.”

A survey conducted as part of the PSO What? initiative also reveals that GPs admit to lacking in knowledge and understanding regarding the effective management of the condition which, it warns, is particularly concerning given people with psoriasis are also at risk of developing other serious associated conditions, such as psoriatic arthritis, cardiovascular disease, inflammatory bowel disease, liver disease, complications with vision and some cancers.

“This new report shines a light on the shortcomings of dermatological training and staffing, which inevitably give rise to sub-optimal psoriasis care. It is essential these issues are addressed if we are to improve patient outcomes, and reduce the burden of the associated comorbidities currently weighing on individuals, health services, the economy, and society as a whole,” said Katherine Murphy, chief executive of the Patients Association.

Dr Anthony Bewley, consultant dermatologist at Whipps Cross and St Bart’s NHS Trust, said it is essential that the current lack of training and formal assessment of practical dermatology skills is addressed.

“Beyond that, we, as healthcare professionals, need to move away from the misconception that psoriasis is ‘just a skin condition’, and look for the best possible whole-person care for each individual. The unfortunate truth is that past failings have seen some patients simply slip through the net. The PSO What? report signals a sea-change, encouraging patients to demand more from their doctors, and to make sure that medical professionals do not undermine their experience of living with psoriasis.”