This quality standard covers the assessment and management of psoriasis in children, young people and adults. For more information see the psoriasis overview.
Psoriasis is an inflammatory skin disease, which most commonly presents as red, scaly plaques. These may vary in extent from a few patches to generalised skin and associated joint involvement. The disease typically follows a relapsing and remitting course, and can result in significant functional, psychological and social morbidity.
The prevalence of psoriasis is estimated to be around 1.3–2.2% in the UK. Men and women are equally affected. Psoriasis can occur at any age, although is uncommon in children (0.71%) and the majority of cases occur before 35 years. Psoriasis is associated with joint disease in a significant proportion of patients (reported in 1 study at 13.8%).
Psoriasis has a significant impact on health and wellbeing with consequent effects on employment and income, underlining the need for prompt, effective treatment, and long-term disease control. Symptoms related to the skin, problems related to treatments, psoriatic arthritis, and the effect of living with a highly visible, stigmatising skin disease have an important bearing on wellbeing. Even people with less severe disease state that psoriasis has a major effect on their day-to-day life.
A variety of treatment options are available, ranging from topical therapies to phototherapy and systemic therapy (non-biological and biological). For most people, psoriasis is managed in primary care, with specialist referral being needed at some point for up to 60% of people. Specialist tertiary care is needed in the very small minority of people with especially complex, treatment-resistant or rare forms of psoriasis. People receiving systemic therapy need ongoing supervision in specialist settings, sometimes with shared care arrangements for drug monitoring in primary care.
A recent UK audit in the adult population found wide variations in practice, particularly in relation to access to specialist treatments (including biological therapy), appropriate drug monitoring, specialist nurse support and psychological services.
NICE quality standards are a concise set of prioritised statements designed to drive measureable quality improvements within a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following outcomes framework published by the Department of Health:
NHS Outcomes Framework 2013/14 (Department of Health, November 2012)
Table 1 shows the outcomes, overarching indicators and improvement areas from the framework that the quality standard could contribute to achieving.
Table 1 NHS Outcomes Framework 2013/14
Overarching indicators and improvement areas
2 Enhancing quality of life for people with long‑term conditions
2 Health‑related quality of life for people with long‑term conditions**
Ensuring people feel supported to manage their condition
2.1 Proportion of people feeling supported to manage their condition**
Reducing time spent in hospital by people with long‑term conditions
2.3i Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults)
4 Ensuring that people have a positive experience of care
4a Patient experience of primary care
4ai GP services
Improving people's experience of outpatient care
4.1 Patient experience of outpatient services
Alignment across the health and social care system
** Indicator complementary with Adult Social Care Outcomes Framework (ASCOF)
The quality standard for psoriasis specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole psoriasis care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to people with psoriasis.
The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality psoriasis service are listed in related quality standards.
The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare practitioners involved in assessing, caring for and treating people with psoriasis should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.