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Background  Dermatological conditions present frequently in general practice, and treatment failure is common due to low adherence with treatments. There has been little research exploring GP consultations for skin problems.    Aim  To describe consultations for skin problems in adults including shared decision making (SDM) around treatment decisions, delivery of self-management advice, and follow-up.    Method  Data were extracted from the One in a Million Study, an archive of 327 videorecorded routine GP adult consultations and linked data. A coding instrument was developed and refined, which was applied to all consultations where a skin problem was identified as having been discussed. SDM was assessed using OPTION. Twenty per cent of the consultations were double coded and inter-rater reliability assessed. Data were analysed using Stata, with descriptive statistics reported.    Results  In total 45 consultations (13.8%) were examined, featuring a mean of 2.2 problems. Of the 100 problem types, 51 were dermatological. Mean time spent on skin problems was 4:16 minutes (29.6% of total duration of consultations with ≥2 problems). SDM for skin problems was low, with mean OPTION score of 10.7 (range 0–35). Self-management advice was given for 47.1% of skin problems (verbal only). Most skin problems (84.3%) were not referred to secondary care; 32.6% of skin problems not referred were seen again in primary care within 12 weeks of the index consultation, of which 35.6% were unplanned.    Conclusion  Skin problems commonly present alongside other complaints. SDM and self-management advice are uncommon. While most dermatological problems are not referred, patients often re-consult for the same problem.

Routine consultations for dermatology problems in adults in general practice: cross-sectional study