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GPs go forth

GPs can safely carry out minor skin surgery, concludes report

Minor skin surgery performed by GPs in primary care is safe and prompt and may be an ‘underused resource’, claim researchers.

An audit of GP self-reported data for minor skin surgery found that most operations – the majority of which were excision biopsies for skin cancer – were conducted within eight weeks and with very few major complications.

Only 0.7% of operations saw major complications develop within two months, and 1.3% developed minor complications.

The audit also revealed that GPs could accurately determine which lesions were malignant or benign.

Published in the British Journal of General Practice, the audit analysed over 6,000 procedures performed by GPs working in three different settings including enhanced services GPs, GPwSIs and Model 2 GPs.

GPwSIs in dermatology identified malignant diagnoses in 93% of cases, and Model 2 GPs in 91% of cases, although GP surgeons working as part of an enhanced service only correctly identified 69% of malignant diagnoses.

The team said the difference could be because of the supervision available and say a managed framework is needed to enable consistency.

The paper stated that GP-performed surgery was ‘prompt with complete treatment delivered within eight weeks’, adding that ‘GP surgeons may be an underused resource.’

They concluded: ‘For UK GPs, it would seem reasonable that, within their competence, cancer and facial surgery should be relaxed but carefully audited.'

Currently, NICE guidance states that GPs should only deal with low-risk basal cell carcinomas in the community. There are ‘currently no plans to update the guidance’, said NICE.

But Dr Jonathan Botting, who designed the audit in the study, said: ‘The level of diagnostic and surgical skills among GPs without specialist training appears far higher than that quoted in evidence used by NICE to formulate their guidance.’

Despite the findings, Dr Botting said that the surgical skills of GPs will continue to be an underused resource due to lack of funding.

He said: ‘Sadly, without the prospect of continued funding, the NHS may lose the very tool that could enable significant financial savings.’

Readers' comments (5)

  • Harley Thespaniel

    But would anyone believe anything in this non-entity of a publication?

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  • Doesn't help that its GP self-reported data. I'm all for GP-cutters, but not sure I would base any conclusions on this either. Let's hope for some more robust study to support the approach.

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  • Assuming its this gentleman, you might also suggest that a GP-cutter who has led nationally for the Royal College of GPs on looking at GP-cutters might not be the most independent of audit-designers for deciding on the value of GP-cutters.

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  • And are we also competent to do injections? I'm sure that we'd need a full week training course for that skill...

    Of COURSE we can do surgery if we trained ! Some of us learned learned all that years ago!

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  • Whether this report is independent or not surely well trained GPs that are properly audited are best placed to do the majority of this work, especially BCCs. SCCs and melanoma's would need appropriate contact with MDT. Needs to be funded properly in primary care and would save significant amounts for the NHS as a whole...

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