Thank you...

As 2022 ends, it is perhaps timely to refect upon the state of the NHS and dermatology. We are at something of an impasse, with exciting new treatments coming along almost by the week (see What’s new in dermatology) countered by increasing demand for all medical services, static realterm funding and the very real pressures facing the acute medical services, whether in primary or secondary care. Similarly, the regulatory model use for the past two decades to manage public services and contracts seems no longer appropriate. Recent highprofle failures are leading to a more general recognition of what we need – a new way to manage public services. A paradigm shift is needed but, by its nature, we don’t know what that will look like, or when it will come.