this type of paradigm shift in the way health services are funded, managed and delivered (174). The strategy presents a compelling vision of a future in which all people have access to health services that are provided in a way that responds to their preferences, are coordinated around their needs and are safe, effective, timely, Global report on psoriasis 28 efficient and of an acceptable quality. This includes a vision where the services available to people are better able to provide a continuum of care that meets all their health needs, in an integrated way, throughout their life course. People-centred health services are an approach to care that consciously adopts the perspectives of individuals, families and communities, and sees them as participants as well as beneficiaries of trusted health systems that respond to their needs and preferences in humane and holistic ways. It requires that people have the education and support they need to make decisions and participate in their own care. Achieving people-centred and integrated health services can generate significant benefits in all countries, whether low-, middle- or high-income, including conflict afflicted and fragile states, small-island states and large federal states. For patients with psoriasis, people-centred care could mean that the general practitioner assesses and considers the full spectrum of the person’s needs, including the issues related to their psoriasis, but also the other issues related to their health and well-being. The general health-care provider would also have access to refer the patient to a specialist dermatologist for a consultation (or use teledermatology consultations to seek the essential specialist input). The primary care provider, based on consultation with the patient, would seamlessly coordinate the inputs from various specialists, including dermatologists, rheumatologists, cardiologists and psychologists. Furthermore, if a dermatologist is not available, a general practitioner should monitor the progress of treatment, and in the case of relapse refer the patient to the appropriate specialists. Box 1. Model for improving psoriasis care on a national basis: the German experience One example of a large-scale programme to improve health care for psoriasis is the German experience. The approach for improving psoriasis care in Germany started in 2005 with a systematic analysis of the quality, outcomes and potential barriers of health care for psoriasis (172). A series of national health-care studies revealed severe deficits in both the access to modern drugs and the lack of a national guidance, and a large number of patients with high disease severity. Following the development of a psoriasis guideline as a matrix of care in 2006, this was systematically implemented in regional psoriasis networks and evaluated in national trials (172). After making only minor initial improvements, national goals on psoriasis care for 2010–2015 were released in a broad national consensus by dermatology societies, patient groups and decision-makers. These goals are: (i) better QoL for the patients; (ii) earlier detection and better treatment of psoriatic arthritis; (iii) other comorbidity; and (iv) better health care for children with psoriasis. About 28 regional psoriasis networks were established throughout the country to coordinate high-level health care for psoriasis patients by dermatological experts. In doing so, the latest follow-up data from 2014, which were randomly collected countrywide, revealed significant improvements both on the clinical level of severity and QoL as well as for indirect costs and days of work lost (172). This shows that once health-care providers and patients have reached a consensus, systematic programmes based on standardization, goal orientation and communication at the patient level as well as on the health system level can be successful. This national programme has served as a model for the European Psoriasis White Paper (167) and could be considered by other countries, including for the management of other chronic (skin) diseases. Standardized tools, diagnosis and treatment Health-care providers and dermatologists should use standardized tools to assess the severity of psoriasis and the impact of the