Dermatology in general practice

R Balfour, E Crawford

In common with other aspects of general practice the management of dermatological problems has changed considerably in recent years. In particular:

• There is an increased expectation from patients, who want an accurate diagnosis and prompt treatment but also expect treatment for even the smallest lesion.

• The management of inflammatory skin conditions no longer requires many weeks of inpatient treatment. "Daily dressing clinics" in hospital dermatology departments enable patients to continue their daily lives while being treated, but still require visits to hospital. In many practices facilities for carrying out dressings by the practice nurse have been developed.

• The demand for specialist services far outstrips supply. Consequently the majority of patients with skin conditions have to be treated by general practitioners. One positive outcome is that there is a greater emphasis on shared care between general practice and hospital specialist departments. This is facilitated by the appointment of dermatology liaison nurses who are able to supervise patient's treatment in the community and, as the name suggests, liaise with both general practice and hospital departments using the resources of each as appropriate.

• General practitioners are increasingly developing special interests and many have part-time posts in specialist departments. In the case of dermatology this enhances their clinical knowledge, which they can bring to bear on the problems in general practice.

Between 10% and 15% of consultations in general practice are for skin related problems, although the actual number of skin conditions seen is probably much higher than this. In one general practice an analysis of 100 consecutive consultations showed that 38 involved some aspect of dermatology. Increasing knowledge of dermatology enables conditions to be diagnosed and treated. Even if the diagnosis is not known it is important to be able to assess the probable importance of dermatological conditions and differentiate those for whom an urgent referral to hospital is required from those needing a specialist opinion to confirm the diagnosis and treatment but for whom there is no great urgency. This is important with the large demands being made on hospital departments with diminished funding and increasing waiting times. In this respect a good working relationship with the local hospital department is a great asset.

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