In the U.K. for more than 50 years, phototherapy has been an established low cost outpatient treatment for psoriasis and other inflammatory skin diseases.
Predominantly a hospital based secondary care service, it is commonly used prior to considering systemic therapy in those patients for whom topical treatment has proved unsatisfactory in moderate to severe disease.
Phototherapy has to be prescribed by a Consultant Dermatologist or accredited practitioner under the supervision of the Consultant, in a face to face consultation. The patient’s pre-assessment must be carried out by a phototherapist. A phototherapist must be a physiotherapist registered with the HCPC or a 1st level registered Nurse. All phototherapy staff must undertake a period of supervised practice with a qualified phototherapist and be signed off as ‘competent’. During this period, clinical notes of patients treated by the trainee should be countersigned by a ‘competent’ phototherapist.
It is recognised that, prior to the Introduction of these Standards, some Phototherapists working long term do not possess this level of Nursing or Physiotherapy qualification. For this group the following applies - if a phototherapist is not either a chartered physiotherapist or a 1st level Registered Nurse, they must demonstrate that:
1. They have been working as a phototherapist in the UK in a recognised phototherapy Unit for a minimum of five years prior to 1st January 2015;
2. They can show that they have been signed off by a recognised Phototherapist* in all relevant competencies.
(*a Chartered Physiotherapist or a 1st level registered Nurse who has undertaken a period of supervised practice with a qualified phototherapist and been signed off as ‘Competent’).
Audits of phototherapy provision have revealed great variation in the quality of service provided between centres. Moves by some commissioners to provide community based phototherapy services has escalated the need for Phototherapy Service Standards, to ensure patients are not placed at risk or harmed. This, along with the legal concerns over the mismanagement and burning/overexposure to phototherapy of patients; has resulted in the development of NICE Accredited Phototherapy Service Guidance and Standards, which provide the necessary clinical and quality governance assurance.