Quality statement 3: Referring to specialist services

Quality statement

People with psoriasis are referred for assessment by a dermatology specialist if indicated.

Rationale

Referral for assessment by a specialist when needed is important given that people with psoriasis may experience relapsing disease, and the fact that some treatments are only available in specialist care or suitable for intermittent use. Most people with psoriasis will need access to secondary care services at some point. Access to specialist advice and support can improve response to treatment and wellbeing.

Quality measures

Structure

Evidence of local arrangements for people with psoriasis to be referred for assessment by a dermatology specialist if indicated.

Data source: Local data collection.

Process

Proportion of people with psoriasis who are referred for assessment by a dermatology specialist if indicated.

Numerator – the number of people in the denominator who are referred for assessment by a dermatology specialist.

Denominator – the number of people with psoriasis who have an indication for referral for assessment by a dermatology specialist.

Data source: Local data collection. Contained in NICE clinical guideline 153 audit support for non-specialist services.

Outcome

Patient experience.

Data source: Local data collection.

What the quality statement means for service providers, healthcare practitioners, and commissioners

Service providers ensure that systems are in place for people with psoriasis to be referred for assessment by a dermatology specialist if indicated.

Healthcare practitioners ensure that people with psoriasis are referred for assessment by a dermatology specialist if indicated.

Commissioners ensure that they commission services for people with psoriasis to be referred for assessment by a dermatology specialist if indicated.

What the quality statement means for patients, service users and carers

People with psoriasis are referred to a dermatology specialist for assessment if it is needed.

Source guidance

Psoriasis: assessment and management (2012, updated 2017) NICE guideline CG153, recommendations 1.2.1.10 (key priority for implementation) and 1.2.1.12

Definitions of terms used in this quality statement

Indications for referral

  • People with generalised pustular psoriasis or erythroderma should be referred immediately for same-day specialist assessment and treatment.

  • Children and young people with any type of psoriasis should be referred to a specialist at presentation.

  • People with psoriasis are indicated for referral for assessment by a dermatology specialist if:

    • there is diagnostic uncertainty or

    • any type of psoriasis is severe or extensive, for example, more than 10% of the body surface is affected or

    • any type of psoriasis cannot be controlled with topical therapy or

    • acute guttate psoriasis needs phototherapy or

    • nail disease has a major functional or cosmetic impact or

    • any type of psoriasis is having a major impact on a person's physical, psychological or social wellbeing.

  • Any person whose skin condition cannot be managed by their GP will need to be referred for an assessment by a specialist. This could be a: consultant dermatologist, specialist registrar, staff and associate specialist doctor, trust grade doctor, clinical assistant, hospital practitioner, dermatology specialist nurse or accredited or trained GP with a special interest, in a hospital-based dermatology service or a community health facility suitable for specialist care.