GPs need better training to improve outcomes for patients with psoriasis

May 1, 2014

GPs need enhanced training to help them to manage patients with the complex, long term condition psoriasis which affects 1.8 million people in the UK, experts from The University of Manchester argue.

Psoriasis can affect anyone and is reported to affect celebrities including Alan Carr and model Cara Delevingne. But often it is a hidden condition.

The inflammatory skin condition is also associated with heart disease, depression and other inflammatory conditions such as Crohn's disease and arthritis.

But research shows even doctors specialising in skin care receive very little training about how to manage psoriasis as a long-term condition with the effects that this condition can have on all aspects of life. As well as the other medical conditions associated with psoriasis, smoking, being overweight, inactivity and excess alcohol use much more common in people with psoriasis and affect flares but patients rarely receive adequate support to make lifestyle changes.

Dr Christine Bundy, one of the theme leads on the National Institute for Health Research (NIHR)-funded Identification and Management of Psoriasis Associated ComorbidiTy (IMPACT) research programme, is involved in the launch of a new training programme for practitioners aiming to improve health outcomes for their patients with psoriasis. This training will officially be launched in Manchester on Thursday 1 May.

Dr Bundy said: "Our research shows in addition to the presence of cardiovascular disease, patients often also have low mood and this impacts on motivation to self-manage psoriasis. In addition, we have reports that most clinicians, even those with a special interest in psoriasis, do not feel skilled or confident in supporting patients to change their lifestyle behaviour to help manage their condition better yet we know evidence based methods to manage mood and behaviour can improve quality of life and help people recover from psoriasis flares quicker.

"Not identifying these additional factors which are often associated with psoriasis is not only bad news for the patients it also has financial implications for the future health spend in the NHS."

Clinicians who do want training in how to support patients often do not have access to a quality assured, relevant and tailored programme to enable them to develop and practice the necessary skills, researchers say. Some are able to attend, usually industry sponsored, training events but access to those events is restricted and the opportunities are ad hoc and not part of any established or accredited programme of continuing professional development.

The world-renowned team from the University of Manchester and Salford Royal NHS Foundation Trust is now launching a pilot programme to better train clinicians in the North West which, if successful, they hope could be rolled out on a larger scale.

Set to train GPs and medics over the next six months, it will involve helping practitioners develop their skills in the management of psoriasis as a long term condition with particular emphasis on supporting motivation to make lifestyle, behaviour changes.

Professor Chris Griffiths, consultant dermatologist at Salford Royal NHS Foundation Trust and IMPACT Principal Investigator, added: "We've looked at the barriers doctors face in treating the patient for all their symptoms.

"A large part of our training will focus on how to have the conversations that can make a difference to people's lives such as noticing whether their psoriasis is affecting other areas of their life for example drinking too much, over-eating, being inactive or feeling low and depressed.

"There's often time pressures in a 10 minute consultation but these techniques are not about adding to doctors' workloads but setting on the right pathway of treatments and lifestyle changes earlier so that they spend fewer years in the wilderness with their psoriasis being treated inadequately."

A survey of some medics questioned about current training highlighted they believe it is insufficient in general and especially inadequate to manage unhealthy behaviour". Another admitted to confusion and said: "I thought of psoriasis primarily as a skin complaint. I am aware that there are systematic problems but I sometimes find it difficult to put the two together".

Patients however reported a need for doctors to recognise that psoriasis was more than a skin complaint. One said: "It's a skin condition but it goes beyond that, it sort of runs deeply…it got to the stage where I was thinking about it so much I actually cancelled meeting my friends. Toby Hadoke, a London-based comedian with psoriasis, said: "It took 25 years for a clinician to say to me, we can manage your and the impact it has on your life, that was a lifeline for me."

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