Title : Confidence in recognising dermatological conditions in UK primary care: A national cross-sectional survey
Abstract:
Background: Skin conditions form a significant part of primary care workload, yet confidence in their recognition and management is variable. This study explored confidence levels across conditions and roles, and examined the impact of additional dermatology training.
Methods: We conducted a cross-sectional online survey of UK primary care clinicians. Respondents reported demographics, role, years in practice, and confidence in recognising 23 skin conditions (0–5 scale). We compared confidence by role and additional training status using heatmaps and forest plots, and analysed free-text responses thematically.
Results: A total of 209 clinicians participated: GPs (45%), advanced practitioners (22%), nurse/practice nurses (6%), pharmacists (6%), paramedics (4%), podiatrists (3%), physician associates (1%), dermatology CNS (1%), GPwERs (5%), and others. Confidence was highest for acne (mean 4.3), eczema (4.2), and urticaria (3.9), and lowest for pemphigus vulgaris (1.9), lichen planus (2.3), and bullous pemphigoid (2.5). Heatmaps showed higher confidence among GPs, GPwERs, and CNS staff, with lower scores among nurses, HCAs, and allied professionals. Additional training significantly increased confidence, particularly for rarer conditions such as seborrhoeic keratosis (+0.88, p<0.001), discoid eczema (+0.83, p<0.001), and hidradenitis suppurativa (+0.74, p=0.002). Most respondents (93%) reported a need for more support, particularly in lesion recognition, skin of colour, and dermoscopy. Free-text comments highlighted difficulties with skin cancer recognition, atypical rashes, and access to timely advice and guidance.
Conclusion: Primary care clinicians report high confidence in common dermatoses but limited confidence in rarer and complex conditions. Additional training has the greatest effect in these areas. Expanded education, practical dermoscopy training, and better representation of skin of colour are urgently needed to support diagnostic accuracy and improve patient outcomes.
