The DCE aims to:
• Raise the profile of dermatology within the NHS.
• Raise awareness of the impact of skin conditions on people’s lives
• Encourage education and training amongst health care professionals
• Improve access to dermatology services across the UK
A Manifesto to improve dermatology services
What is the impact of skin diseases in the UK?
A common problem
Over half the UK population experience a skin condition each year, resulting in nearly 13 million GP consultations (in England and Wales) and 0.8 million referrals for specialist advice. Skin conditions are the most common reason for people to consult their GP with a new problem1
A major impact on patients’ lives
Skin disease caused nearly 4,000 deaths in 2005, including 1,817 deaths due to malignant melanoma, (nearly twice as many as cervical cancer).1
Quality of life can be significantly impaired by skin diseases such as psoriasis, atopic eczema, vitiligo5 and acne, at times, even to a greater extent than life-threatening conditions such as cancer.1
• Psoriasis patients can be affected psychologically, with an increased rate of depression and suicidal ideation in hospital psoriasis inpatients and outpatients (5.5%), rising to 7.2% for inpatients only.2 Patients with severe psoriasis have an increased mortality compared to the general population, with men dying on average 3.5 years earlier and women 4.4 years earlier.3
• “My Vitiligo started when I was 14 years old. At 18 I started to suffer from Ankylosing Spondylitis, followed by Crohns disease at 24. At 30, after many years of oral steroids, osteoporosis was confirmed. Last year I was diagnosed with rheumatoid arthritis. I have also had many bouts of Iritis over the years and to top it all off I also have Alpha-1 Antitrypsin Deficiency, a rare genetic disorder which causes rapid destruction of lung tissue and at 33 I contracted emphysema. None of these diseases can be cured; only controlled. I have come to terms with the pain and discomfort all these diseases bring – but I have never been able to come to terms with having Vitiligo, and I still dread every summer”
• Specific issues relating to the psychological impact of childhood eczema on children and their families are well documented, with sleeplessness and its consequences leading to impaired psycho-social functioning of the child and the family. Children with very troublesome atopic eczema may need disability allowance to help with the cost of extra care required from family or paid carers.1
• There is a significant psychological morbidity for acne patients including anxiety, depression, suicidal ideation and suicide.1
A major impact on the workplace
Skin disease is the second most common occupational disease in the EU after musculoskeletal disorders. Contact dermatitis accounts for 70-90%, urticaria less than 10%, others include folliculitis/acne, infections, neoplasia, hyperpigmentation and vitiligo.
Those at highest risk include hairdressers, health care workers, cleaners, construction workers, cooks and caterers, mechanics, metalworkers and vehicle assemblers, chemical/petroleum plant operatives, agricultural workers. 4
A major need for improved services
There is no compulsory requirement for dermatology training for primary care health professionals. The ratio of consultant dermatologists to the population remains low in the UK at 1:130,000 with many only available part-time. The average for France, Germany and Italy is 1:16,000.1
1. Skin Conditions in the UK: Health Care Needs Assessment , Julia Schofield, Douglas Grindlay and Hywel Williams. Centre of Evidence Based Dermatology, University of Nottingham.
2. Gelfand JM, Troxel AB, Lewis JD, et al. The risk of mortality in patients with psoriasis: results from a population-based study. Arch Dermatol 2007; 143: 1493-1499
3. Gupta MA, Gupta AK. Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol 1998; 139: 846-850.
4. European Agency for Safety and Health. European Risk Observatory Report EN8. Expert forecast on emerging chemical risks related to occupational safety and health. Office for Official Publications of the European Community.
5. Bewley A, Talsania N, Lamb B, Vitiligo is more than skin deep: a survey of members of the Vitiligo Society. Clinical and Experimental Dermatology Volume 35, Issue 7, pages 736–739, October 2010
Key Manifesto Requirements in Skin Care
The Dermatology Council of England believes that the following minimum standards should apply to the provision of skin care services in the UK. The Council therefore calls upon the Government to commit to providing these standards.
1. Equitable access to the full range of dermatology services throughout the UK through the development of agreed gold standards for all dermatology services, no matter where a person lives. When health-care targets exist, they should not disadvantage any group of patients.
2. All dermatology services should provide holistic support, treatment and care. In order to achieve gold standard status, all services must fund and offer access to psycho-social support, including specialist nurses, camouflage services and where appropriate, counselling and psychotherapy.
3. Minimum requirements for dermatology patients should include:
ready access to a healthcare practitioner who is adequately trained and experienced enough to diagnose and manage their condition, and has demonstrated that their training is up to date. This should apply to the assessment of both skin cancer and inflammatory skin disease.
prompt and easy access to specialist care, when required
continued follow up care, if required, by the same team
free prescriptions if their skin condition is chronic
access to a comprehensive skin surgery service and a full range of medication as prescribed
4. Provision of high quality dermatological surgery for the surgical management of skin cancer, including high quality Mohs micrographic surgery when required.
5. As with cancer services, 'supportive care' must become integral to dermatology.
6. Medical undergraduate training and GP training should be sufficient at least to ensure that all doctors have a basic knowledge in dermatology for common and important diagnoses.
7. Basic nurse and pharmacist training should also include dermatology and those specialising in dermatology should have easy access to post-qualification training if they desire it.
8. Patients should be properly consulted in the design of their local dermatology services, particularly if there are to be major changes to the way that skin care services are to be delivered. It should not be possible for a service provider to withdraw from their role without consultation with patient representatives.