Beyond skin: the need for a new approach to the management of psoriasis in primary care, and Iona Heath’s Harveian Oration

A rock and a hard place

“…2 Reports from the King's Fund back up the experience across the country, that many referrals from GPs to secondary care reflect an assumption that secondary care management of risk through investigation is preferable to taking the risk on ourselves and trying to prevent the transfer from illness to disease. 3,4 We are trying to make sure that patients with illnesses like psoriasis are able to be seen more quickly than they can at present, as many outpatient clinics are clogged up with people who didn't need to be there in the first place, are being seen for too long, and where their care is not being shared between the GP practice and specialists. We have successfully transferred many patients with type 2 diabetes from hospital to primary care, assisted by diabetes specialist nurses, with agreement from consultant diabetologists.…”