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Pete Williams, general manager, UK and Ireland, at Incyte, argues that the British health system hasn’t kept pace with the expansion of innovation, and for conditions like atopic dermatitis.
We stand at a critical juncture for the future of the NHS. The publication of the government’s 10 Year Health Plan last July set a welcome direction and ambition for change across the NHS based on three core shifts – hospital to community, analogue to digital, and sickness to prevention. However, details around implementation and how progress is to be tracked still lack clarity. The test of the plan now lies not in its ambition, but in where delivery starts.
From my perspective, we must first identify areas that can function as early exemplars of scalable reform. Chronic conditions such as atopic dermatitis are well-positioned to be the NHS’s first proving ground for delivering government ambitions and demonstrate a replicable blueprint for other chronic disease areas.
A pathway ill-equipped for proactive management
Atopic dermatitis is a relapsing-remitting condition that affects approximately 1.5 million UK adults, and requires ongoing management, which generates repeated demand across all areas of the care pathway – from GP appointments and referrals to outpatient reviews and treatment escalation. The crisis facing NHS dermatological services has created particularly acute challenges for those living with chronic skin conditions like atopic dermatitis.
Bottlenecks persist as dermatology departments respond to growing numbers of urgent referrals for skin cancer, while the specialist workforce, including both consultant dermatologists and specialist dermatology nurses, is under-resourced. With one consultant for every 72,200 patients – around 15% below the recommended service requirement – services are left strained, and approximately 35% of NHS dermatology patients are waiting longer than the target of 18 weeks to receive treatment.
For patients, the issue here is not a single delayed appointment but the cumulative burden of a pathway ill-equipped for long-term proactive management of the condition. Without effective control, the chronic cycle of patient need creates repeated demand across the system and the individual – living with poorly controlled, visible, uncomfortable and psychologically burdensome disease for too long.
Addressing the challenges in chronic condition care requires a fundamental rethink of the patient pathway for conditions like atopic dermatitis. In dermatology, the workforce challenges make pathway reform essential rather than optional. Thankfully, the required solutions can be designed and delivered in line with the three foundational shifts set out in the plan.
Dermatology pathways are particularly suited to the planned rebalancing from hospital to community care. The impact of innovation here has already been demonstrated through the success of teledermatology models that enable remote triage, review, and monitoring, supported by digital imagery. These capabilities have helped to protect NHS capacity and enhance efficiency while empowering patients to manage their care closer to home.
Similar benefits could be achieved with greater access to innovative treatments that allow patients to manage their condition at home. A more proactive and personalised approach can reduce psychosocial burden while shifting care from reactive symptom management towards prevention. The best treatment plans do more than reactively treat symptoms – they take a holistic approach that reflects patients’ preferences and quality of life.
Solving structural disconnects
The UK health system hasn’t kept pace with the expansion of innovation, and for conditions like atopic dermatitis, a key challenge is ensuring new treatments can be deployed in the right care settings. In dermatology, treatments that could support earlier intervention and care closer to home may remain anchored in secondary care because the access, pricing and reimbursement infrastructure has not kept pace with the NHS’s stated ambition to shift care into the community.
For example, confidential discounts and Patient Access Scheme arrangements are typically only possible for medicines prescribed in secondary care, meaning that patients do not get access to new and innovative medicines in primary care settings closer to their home. It’s critical that pathway design, workforce planning, pricing mechanisms and commercial access models work in alignment to truly move appropriate care out of hospitals.
So, how does the health sector as a whole support the change we want to see? There is huge potential for purposeful pathway reform in dermatology to help deliver on the government’s long-term ambitions for healthcare. Turning ambition into delivery means backing earlier control, practical digital tools, and community-based models in high-volume long-term conditions. These are areas where progress can be demonstrated quickly, but only if joined-up thinking is prioritised.
The 10 Year Plan was developed with great optimism for the future of the NHS, but expectations for impact to be evidenced are rapidly escalating. If we can successfully redesign care for chronic conditions such as atopic dermatitis, we will demonstrate how practical reform is possible across a much wider range of disease areas. This provides patients greater agency in care decisions, eases pressures on overstretched services and helps build a health system truly fit to tackle the challenges of the future.
