Unlocking the challenges in psoriasis care, Bristol Myers Squibb explores the impact beyond skin, addressing diagnosis hurdles, regional inequities, and collaborative solutions for enhanced patient outcomes.
This article has been written and funded by Bristol Myers Squibb UK & Ireland.
Psoriasis, a chronic immune-mediated inflammatory disease, is far more than skin deep. For many people its impact can be significant, also infiltrating their emotional and psychological wellbeing. In a survey of more than 500 psoriasis patients in the UK, 93 per cent reported that they have low self-esteem due to living with a highly visible skin condition.[i]
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This article is based upon insights from disease area specialists working for Bristol Myers Squibb (BMS) regarding the current and future management of psoriasis.
The disease area specialist (DAS) at BMS is a member of the head office medical affairs team with a multifaceted role. The DAS is responsible for providing subject matter expertise in their therapy area and acting as a critical bridge between research and clinical trials and commercial teams in the business.
UK patients face challenges at diagnosis
A key challenge in diagnosing psoriasis is ensuring there is an adequately trained and equipped primary care workforce. This can mean that many patients have different experiences when it comes to reaching a diagnosis and – for a variety of reasons – some often wait many years for effective treatment to be initiated. In practice, around 75 per cent of all NHS consultations for skin problems take place in GP surgeries, yet many GPs receive little formal dermatology training.[ii] Moreover, considerable variation in the number of dermatology consultants has been identified, with the six largest trusts having nearly as many consultants as the smallest 70 trusts combined.[ii]
Dr Waise Haider, disease area specialist, dermatology, at BMS and former GP partner, comments, “The result of limited dermatology specific training means there is generally a lack of confidence in managing skin disease. In turn, many referrals of benign skin conditions are made through the skin cancer pathway, reducing capacity in the secondary care setting. All GP practices are set up slightly differently and there are significant differences between urban and rural practices, meaning that no one size fits all, however there are solutions that can be implemented that will enable quicker access to specialist care for patients who need it most”.
Working together to overcome challenges in primary care
By supporting the upskilling of GPs to accurately and confidently diagnose benign skin lesions, the number of these referrals into the urgent skin cancer referral pathway might decrease, helping to lift the burden from the system. This will allow secondary care specialists more time to see patients who require their expertise the most.
Dr Haider adds, “There isn’t going to be an overnight solution to address current challenges within the primary care setting, and it’s important to remember that not every option will be a right fit or investment for each practice. However, there are now mobile apps, artificial intelligence and teledermatology services which practices can consider to help support diagnosis and care. These can be used to give clinicians the confidence to triage patients, expedite a psoriasis diagnosis and cut waiting times, ultimately working towards ensuring that more patients receive effective treatment in a timely manner”.
Alongside key stakeholders and partners, the pharmaceutical industry also has an opportunity to support the NHS in implementing longer-term solutions. These could include supporting professional bodies such as the British Association of Dermatology or the Primary Care Dermatology Society to implement training programmes, providing GPs with the latest knowledge and advances in dermatology.
Psoriasis care in the second-line setting
Significant regional disparities in access to psoriasis services across the UK presents an additional challenge for psoriasis patients. In particular, variation in the number of dermatology consultants available across England, paired with the high level of vacancies in some regions, adds pressure to an already overwhelmed system. As a result, only 15 per cent of dermatology departments are reporting equity of access to services for all dermatology patients.[iii] Health inequalities and associated variation in access were also exacerbated during the covid-19 pandemic, with higher waiting times for a first outpatient appointment for Black, Asian and other ethnic groups when compared to white communities.[iv]
Dr Ali Rogers, disease area specialist, dermatology, and dermatology specialist doctor at BMS, says, “The current crisis in dermatology is multifactorial, resulting from a huge increase in demand over the last decade and a stark mismatch between the resources allocated, which includes staffing and training of the primary and secondary care workforce, and the resources needed”.
A collaborative approach to improving patient pathways
More than most other specialties, dermatology requires an effective interface between primary and secondary care.[ii] Once a patient is diagnosed, there is dual responsibility between primary and secondary care teams to effectively manage psoriasis patients. If learning and knowledge around the appropriate management and care of psoriasis is shared between settings, then patients should be able to access the care they need at an earlier stage and have a better experience of support to manage their condition.
Dr Rogers adds, “Improved communication and knowledge exchange within the healthcare community builds trust between practitioners and can drive better patient management across the different care settings. Adopting new ways of working to deliver effective care with integrated roles and technology will be important as we continue to work together to improve access and health equity for all people living with psoriasis. There is more we can do to focus our attention on dermatology and by recognising the pressures faced within our current care system, we can look towards future solutions to provide the best possible care for psoriasis patients”.
Achieving the best in psoriasis care for all
BMS is inspired by a single vision: transforming patients’ lives through science. In pursuit of this, BMS is working alongside key stakeholders in the psoriasis disease pathway to provide in-depth insights into the current psoriasis treatment landscape, shine a light on solutions that will ultimately drive improvements in patient outcomes and provide meaningful support to people living with psoriasis.
Job code: IMM-GB-2300509
Date of preparation: December 2023
References
[i] Blackstone, B. Patel & Bewley, A. Assessing and Improving Psychological Well-Being in Psoriasis: Considerations for the Clinician, Psoriasis Auckland, March 2022, Vol 12, Number 1, Pages 25-33. Last Accessed: November 2023.
[ii] GIRFT (2021) Dermatology GIRFT Programme National Specialty Report. Available at: https://www.gettingitrightfirsttime.co.uk/medical-specialties/dermatology/. Last Accessed: November 2023.
[iii] British Association of Dermatologists (2019). Delivering care and training a sustainable multi-specialty and multi-professional workforce: An audit of UK dermatology outpatient departments against the 16 principles of the Royal College of Physicians’ report. Available at: https://www.skinhealthinfo.org. uk/wp-content/uploads/2019/12/BAD-RCP-OUTPATIENT-EXECUTIVESUMMARY-002-1.pdf. Last Accessed: November 2023.
[iv] Secondary care data is taken from the English Hospital Episode Statistics (HES) database produced by NHS Digital, Copyright © 2022, the Health and Social Care Information Centre. Re-used with the permission of the Health and Social Care Information Centre. All rights reserved. Last accessed: November 2023.
