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Could APMS be used to close GPs' practices?

GPs and specialists have criticised proposed NICE guidance on skin cancer referrals for failing to address widespread confusion over diagnosing melanomas.

Skin cancer experts said final draft guidelines, due to come into force in March next year, lack advice on when to refer suspicious moles, despite complaints from dermatology departments that GPs often refer inappropriately.

And fears have been raised that the new guidance could cause an increase in inappropriate referrals by confused GPs, rendering the Government's two-week guidelines unworkable and overwhelming dermatology departments.

Audits have shown that only 6 per cent of referrals for suspected melanomas result in a cancer diagnosis, compared with 10 per cent for suspected breast cancer, said Dr Russell Thorpe, a GP in St Anne's, Lancashire, who gave oral evidence to the recent All-Party Parliamentary Group on Cancer investigation into cancer referrals.

'The guidance mentions a seven-point checklist but doesn't go on to say how it should be used. This is something we need strong guidance on but it's a blank,' he said.

The British Association of Dermatologists has criticised the guidance from the outset, commenting that it was more likely to increase inappropriate referrals than help GPs spot difficult cases.

Dr Nick Brown, a GP in Chippenham and cancer lead for Kennet and North Wilts PCT, agreed the guidelines were unlikely to help GPs spot more melanomas or reduce the number of non-melanoma excisions.

'To pick up early melanomas we're going to have to remove a certain number of moles,' he said. 'I can't see the value of having too many rules and I'm not sure GPs are even going to read the guidelines.'

Dr Brown also criticised recommendations that removal of suspected melanoma in primary care should be avoided.

Guideline development group chair Dr Ivan Cox, a GP in Birmingham, said he could not respond to individual criticisms while NICE was considering changes to the draft.

By Emma Wilkinson

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