Summary
The significant psychological impact of skin disease and the need for dedicated psychodermatology services is well recognised. Despite this, psychodermatology provision across the UK is insufficient, with geographical variation and long waiting lists. Doctors across the country are unable to access specialist psychodermatology care, with patients waiting over 18 months. Delays in patient care lead to increased patient distress, worsening psychosis, risk of disengagement and poorer overall prognosis as illness goes untreated. Establishing a national level, multidisciplinary team (MDT) meeting was therefore a priority for Barts Health NHS Trust to help clinicians managing psychodermatology patients without support in their own region.
Method
Specialist psychodermatology services are extremely limited and delays in treatment worsen prognosis. The lack of approved guidelines in this area adds to clinician hesitancy in managing cases locally. The aims of the service were to: provide remote advice to enable local treatment, bridging the gap between appointments in specialist services and reducing the need for specialist referral; reduce patient distress and burden associated with delays in speciality assessment; increase clinician confidence in psychodermatological management, plus assess the cost-effectiveness of a virtual MDT and how this could benefit the wider NHS. Outcome assessments included case analysis, clinician feedback and the need for specialist referral. To deliver the service, a MDT lead was identified and a core/stakeholder team was established. The meeting was proposed to be held monthly for 60 minutes. A secure hosting platform was selected and ways to ensure patient and team security were discussed. An MDT proforma was designed. These steps were delivered over a three-month period.
Results
The virtual meeting is now an established service. Over 20 meetings have been held since November 2020, each discussing several cases. Conditions discussed have included body-focused repetitive behaviours, delusional disorders, personality disorders, medically unexplained physical symptoms, body dysmorphia, dermatitis artefacta and autistic spectrum disorders. Of all the cases discussed, only one needed tertiary review. The rest remained in their local departments, reducing the burden on specialist waiting lists and facilitating local patient care. Service feedback from clinicians was 100% positive. Informal feedback from patients to their primary dermatologist showed a positive impact on care. Demand for the MDT is increasing.
Sustainability and Spread
This service has shown sustainability with minimal use of NHS resources. Clinicians have asked to attend the MDT regularly, even when they do not have a patient to discuss. This extends beyond dermatology services to GPs and mental health teams. Hence, it has become a resource for sharing practice and education. The virtual MDT forms part of the national service run from the Royal London Hospital, which will ensure its longevity. The permanent clinical research fellow post in psychodermatology supports the running of the MDT. The preliminary outcome findings will be presented internationally at the World Congress of Dermatology, advancing international impact.
