Anger as specialists block GPs from developing carpal tunnel services

By Nigel Praities

Exclusive: Specialists have been accused of protectionism after launching a campaign to block the development of services for patients with carpal tunnel syndrome in primary care.

In a recent edict to its members, the British Society for the Surgery of the Hand said GPs did not possess the skills to diagnose carpal tunnel syndrome and that specialists should refuse all requests to train GPs wishing to set up new services in primary care.

The instructions are set out in a recent letter to members, obtained by Pulse, from Mr David Shewring, honorary secretary of the BSSH - but the intervention has prompted a furious response from the RCGP lead for minor surgery and other GPs with an interest.

Mr Shewring wrote: ‘With regards to GP involvement, our principle has been to promote a consultant-led team of which GPs can be a part, so that the quality of decision-making and execution of the process can be maintained.'

‘It is inappropriate for GPs to perform carpal tunnel decompression independently and in a primary care setting.'

‘Council recommends that if individual society members are approached by GPs wishing to set up such a service in a primary care setting, this should be declined.'

The move comes at a febrile time, with consultants and GPs meeting to try and dispell tension over the Government's plans for commissioning. It also follows a heated dispute between GP leaders, NICE and dermatology specialists over the quality of minor surgery for skin cancer in primary care.

Dr Jonathan Botting, RCGP clinical champion for minor surgery and a GP in Barnes, south west London, rejected the arguments made by BSSH, saying some carpal tunnel services in primary care were ‘as good as if not better' as hospital-based services.

‘As GPs we undertake a wide range of specialist interventions, many of them as demanding as carpal tunnel surgery.'

‘With commissioning shifting back to primary care it will be sensible for hospital colleagues to work with, not against primary care to develop services,' he said.

Dr Martin Kittel, a minor surgery GPSI in Bracknell, said he often offered patients steroid injections for carpal tunnel syndrome and he knew of GP colleagues successfully carrying out hand surgery.

‘It doesn't matter what status a doctor has and whether or not they are primary or secondary care based. All that matters is that the doctor does good work.'

‘This is a thinly-veiled attempt to protect consultant's income under the premise of good patient care,' he said.

Click here to read the full letter from the BSSH