GP trainees have a “lack of training in dermatology”
Dermatology The NHS would save a fortune long-term if better dermatology education was given at medical school, says Dr George Moncrieff, Chair of the Dermatology Council for England.
Last year, the Dermatology Council for England (DCE) audited every medical school in England via FOI (Freedom of Information) requests, Dr George Moncrieff explains why.
"We are concerned about the general lack of available dermatology education for doctors, particularly for those going into general practice.
Even less emphasis than before
"The audit was something that had been carried out before — and an alarming lack of emphasis on dermatology had been demonstrated then.
"In some cases, there is less than a week in total, dedicated to dermatology in the entire 5 or 6-year course."
"Unfortunately we discovered that it has diminished further. At some schools, there is less than one week in total during the entire 5 or 6-year undergraduate course and other schools are thinking of taking the subject out of their curriculum completely. Many doctors have missed all undergraduate teaching in dermatology as they were away on holiday during that short spell of teaching."
Why do grads need extra training?
"Evidence shows that there is a considerable amount of dermatology in general practice: it's potentially as much as 14 per cent of a GP's total workload. This means it is crucial for undergraduates to receive adequate training.
"At any one time, 50% of us have a problem with our skin and require professional advice."
"Plus, one in four of us consult a doctor with a skin problem every year, and 95 per cent of all skin problems are managed entirely in primary care. This lack of education doesn't make sense because the skin is the largest organ in the body and causes disability and stigma way beyond the actual severity of a person's disease."
Flaws in the system
"Take skin cancer diagnosis. When a GP is presented with a lesion, they are often concerned they'll miss a melanoma so they refer it to a specialist to be on the safe side. Yet, these skin specialists say that about 80 per cent of skin cancer referrals they receive from GPs are obviously benign. In this case, the patient goes through a living hell for two weeks — and when they finally see a specialist it takes them all of 30 seconds to recognise that there is nothing to worry about.
"Skin problems of all severities cause disability and stigma."
"This lack of GP training is frightening patients, it's a waste of resources, and it's overwhelming secondary care. We discovered that six trusts in the country have had to close their doors completely to inflammatory skin disease referrals because they were totally overloaded with demands for skin cancer referrals."
Cuts beyond training
"Up and down the country, Clinical Commissioning Groups (CCGs) are having difficulties balancing their books, so are required to make cuts... and provision of emollients is an easy target. I'm aware of numerous areas around the country where emollients are being removed or restricted on prescription. Yet evidence which I've been involved with — not yet published — shows that effective use of emollients can significantly reduce the use of antimicrobials as well as potent topical steroids.
"Emollients are being removed or restricted on prescription, even though they reduce the use of antimicrobials and potent topical steroids."
"Landmark evidence from 2014 shows that if you give emollients once a day to babies who are at high risk of developing atopic disease (eczema, asthma, hay fever), you halve the number of children who have eczema at six months. That's phenomenal, because they are then less likely to have problems with food allergies, or develop asthma or hay fever in later life. We shouldn't be trying to treat asthma. We should be trying to prevent it. And you do that by protecting the skin's barrier. It's no good asking a patient to buy a cream over the counter, because they usually then use it inadequately."
What would better provsion mean?
"With better undergraduate education and minimal costs for preventative treatment, the NHS would make massive long-term savings of billions. We would also save lives, give those affected a better quality of life, and society would benefit because there would be less people off work.
"But it needs a body such as The Royal College of General Practitioners to highlight the issue. That would carry more weight than an individual like me speaking on behalf of the DCE. But it's urgent because even if today all our medical schools said: 'Dermatology matters to our graduates going into general practice!' things would still move slowly.
"Doctors have six years of training, followed by two years and then three or four years before they become a principal in General Practice That's 11 years or so before we even begin to get a few doctors trickling into the NHS who have learnt a bit about dermatology."