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CAMHS won't see you now

GPs must show they can do minor surgery

Dr Daniel Burrow is unhappy at being disallowed from removing basal cell carcinomas because of NICE guidance.

In view of his qualifications and experience, it is more than likely he is capable of doing this very well, but these days demonstration of competence is required. NICE skin cancer guidance has been out for two years and is now being enforced - hospital doctors are feeling the pinch too.

Working both in a hospital skin cancer unit and as an accredited GPSI, I am aware of the wide range of GPs' abilities at diagnosing skin lesions. I see incompletely excised lesions, recurrence after cryotherapy or curettage and false reassurance of patients with melanoma. Some surgeons (both hospital and GP) only seem to know about excision and not other options.

Treating BCCs is not beyond the skill of any GP, but can't be done on a casual basis. Mentoring, teamwork, CPD and audit are required. GPs treating four or five BCCs a year ought to stop and those doing a dozen or more should develop a recognised role, get a consultant mentor, treat patients to an audited standard - and be appropriately compensated for the time spent doing audits and so on.

Dr Mark Goodfield of the British Association of Dermatologists is not wrong to ask that GPs treating skin cancer should be required to demonstrate suitable skills.

At the other end of the scale, many colleagues seem to lack the confidence to treat Bowen's disease and actinic keratosis, which the same NICE guidance says should be treated by GPs.

From Dr Stephen Hayes, GP in Southampton and committee member of the Primary Care Dermatology Society

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