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<p>As advised in the Getting it Right First Time (GIRFT) national report on dermatology,
published in August 2021, 56% of trusts reported that they had to wait for commissioner
approval before prescribing drugs approved by the National Institute for Health and
Care Excellence (NICE), and 12% of trusts said they had been told by clinical commissioning
groups that they could not prescribe certain NICE-approved biologics for psoriasis
at the time of NHS England’s data questionnaire in 2018/19.</p><p>During GIRFT’s subsequent
deep dives into the 110 trusts with significant dermatology activity, it became apparent
that there was ongoing variation in the way trusts adopt NICE guidelines. While some
allow clinicians to prescribe drugs as soon as they are NICE approved, others have
processes in place which can produce delays of more than a year in some cases.</p><p>GIRFT
is aiming to publish trust- and system-level data for dermatology on the Model Health
System in early 2024, enabling dermatology clinicians and managers to monitor their
variation in provision of care, services, and treatments for skin disorders. Specific
metrics for inflammatory skin disorders, including biologic prescribing for psoriasis
and eczema, will be included. The aim is to use this data to inform the dermatology
element of GIRFT’s Further Faster programme to help target unwarranted variation in
care provision for inflammatory skin disease. The Further Faster programme supports
providers to deliver rapid clinical transformation to reduce 52-week waits.</p><p>There
are no plans to introduce specific targets to adopt the NHS England guidance on Referral
Optimisation for people with skin conditions. The Outpatient Recovery & Transformation
Programme in NHS England will continue to promote the guidance through NHS England
regional teams, integrated care boards and directly to provider organisations.</p><p>In
addition, specific engagement events, such as the webinar delivered on 21 November
2023, will continue to reinforce the need for appropriate and timely referral optimisation
across skin care pathways. The programme is working closely with GIRFT and the Further
Faster teams to ensure that referral optimisation is seen as a valuable tool to effectively
manage the skin care pathway. Through this effort to engage the system combined with
the publication of consistent guidance and evidence across the whole skin care pathway,
it is hoped that variation can be reduced, across pathway implementation.</p><p>It
should be recognised that there may be appropriate clinical reasons for some regional
or local variation, so it is important to ensure that all patients who need specialist
skincare have equal access. The programme will look to review data over the course
of the year to understand the impact and consider relevant next steps.</p>
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