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CAMHS won't see you now

GPs turning their backs on minor ops

By Nigel Praities

The number of ‘specialist' procedures carried out in primary care has crashed over the last year, in the clearest evidence yet of the impact of the row over GP minor surgery.

Official figures from the Department of Health show a 17% drop in the number of procedures done in practices that would normally be carried out in hospital.

The fall, from 895,000 in 2007/8 to 737,400 in 2008/9, has been attributed by GPs to the furious standoff over GP minor surgery, which appears to be crippling the Government's care closer to home drive. At the same time, there was a 14% increase in hospital outpatient procedures.

The figures add to pressure on NICE to release details of the compromise hammered out by the GPC and RCGP with the British Association of Dermatologists in April, which is set to release many GP surgeons from the strictest reading of the rules.

The institute is due to be releasing a statement on how its skin cancer guidance should be interpreted later this month.

Over the last year, DH figures also reveal the overall number of GPSIs fell by 4%, suggesting tough new accreditation standards are acting as a deterrent to some.

Pulse revealed earlier this year that NICE's controversial skin cancer guidance appeared to be fuelling a sharp rise in hospital activity, with GP dermatology referrals rising by a quarter year on year in the last nine months of 2008.

The latest figures suggest this increase has come at the expense of operations that would have been conducted in GP practices.

Dr Stephen Hayes, a GPSI in dermatology in Southampton and a member of the Primary Care Dermatology Society committee, said the figures showed GPs were ‘terrorised' by the defence organisations and disillusioned with NICE guidelines.

‘The NICE skin cancer guidance has sent out a message that has discouraged GPs from doing surgery. GPs are saying "I'm not getting paid much for this work, the authorities are saying I am not to be trusted, so I will refer".'

Dr Selvaratnam Arulrajah, a GPSI in minor surgery in South London, said a letter from his PCT asking GPs to refer all suspicious lesions had resulted in less minor surgery being conducted by practices.

Dr Mark Goodfield, president of the British Association of Dermatologists, said: ‘Any decrease in minor surgery in primary care could have a number of possible explanations, such as a decision to refer more for clinical reasons, for example NICE guidance, or because GPs have just decided to limit their surgery.'

Change in workload

-17% Number of procedures carried out by primary care staff
+14% Other outpatient procedures in hospital:
-4% Number of GPSIs
+0.1% Secondary care consultations in carried out by primary care staff:

Source: DH referrals and attendances statistics, 2006/07 to 2007/08

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