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How dare they accuse us of minor surgery incompetence?

I read the comments from Professor John Primrose in your article on GP minor surgery with incredulity and anger.

He talks of 'clear deficiencies' in GPs' ability to recognise malignant lesions and warns: 'The consequences of putting a melanoma in the bin are utterly inexcusable.' Professor Primrose damns the whole of general practice with these sweeping statements.

I have not seen details of the study, but it hardly seems surprising that Professor Primrose has found in favour of secondary care. I am a GP in his catchment area with 30 years' experience treating skin cancers in both secondary and primary care. I diagnose and remove skin cancers, mostly rodent ulcers, and know my limitations and when to refer on to secondary care.

The number of such lesions in a practice of our size is not great - between 20 and 30 a year - but added to other dermatological work and our resultant low referral rate to secondary care, these activities have made significant financial savings for the NHS.

The reward for my activities, which I closely monitor and for which I achieved surgical accreditation under the Red Book, is to receive restrictive NICE guidance and read Professor Primrose's comments. I was not included in the study and I suspect neither were many other similar practitioners.

Why not closely monitor activity, maintain standards and require interested GPs to become surgically accredited? Be positive, not negative.

GPs used to be encouraged to develop special interests, but this seems no longer of concern to the Department of Health, which underestimates the value of GP activity in terms of financial savings, job satisfaction and the convenience for the patient.

From Dr Martin Mitchell, Romsey, Hampshire

Your article about minor surgery quotes research stating that the cost of minor surgery in general practice is £450.

I wonder whether this is per procedure or per session of multiple procedures. If it is per single procedure, that figure is way off the mark - one-fifth of that would be closer.

From Dr David Lukey, Loughton, Essex

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