The Skin Care Campaign (SCC) has sent a letter to all primary care organisations about the variability of funding and implementation of NICE guidance for the immunomodulator drugs efalizumab (Raptiva) and etanercept (Enbrel).
NICE guidelines recommend that either drug be used to treat adults with severe plaque psoriasis when standard systemic treatments fail or when the patient is intolerant of or has a contraindication to these treatments.
SCC chief executive Peter Lapsley said that some patients faced long delays for immunomodulator treatment despite the guidance. He said he was aware of a modest number of cases but believed that this was likely to be the tip of the iceberg.
‘We understand that there are numerous examples of trusts taking longer then 90 days to find the funding for NICE guidance and slowing things down to the start of the new financial year,’ he said.
He added that including dermatology in the quality framework would ease the problems: ‘It would focus the minds of those who are responsible for the funding of treatments in NHS trusts.’
Mr Lapsley claimed that GPs tended to be dismissive of skin disease, despite the evidence of the severity of the impact of skin disease on quality of life.
Cost of treatment
Professor Peter Friedmann, professor of dermatology at Southampton University, backed the campaign and said that, although the cost of the drugs was high, there were savings to be made.
‘A course of one of these psoriasis drugs can cost up to £12,000 per year per patient. However, if a psoriasis patient is referred to hospital, a three-week stay costs £11,000,’ he said.
‘These drugs can restore the quality of life for people with psoriasis, but they are being introduced slowly because of time wasting by district prescribing committees.’
Professor Friedmann blamed the variations in implementing the NICE guidance on GPs not being sufficiently informed about skin disease. GPs see skin disease patients daily, but only receive six days’ worth of dermatology training during their medical education, he said.
However, GP Dr Stephen Kownacki, chairman of the Primary Care Dermatology Society, said that variation in implementation of NICE guidance was inevitable in dermatology.
‘The same treatment can work differently depending on the particular skin type of the patient.’
Dr Kownacki said that PCTs would opt for relatively inexpensive treatments because PCTs did take dermatology seriously.
However, NICE obliges PCTs to fund psoriasis drugs if a patient has tried all other treatments, he said.