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It’s GP surgeons versus the BAD guys

GP minor surgery may have won a battle this week, but the war is not yet won...

GP minor surgery may have won a battle this week, but the war is not yet won...

The British Association of Dermatologists seems to have been making a concerted effort to live up to its acronym. It has demonstrated, over the past few years, just what an effective lobbying organisation it is for the interests of dermatology specialists, aggressively campaigning against the shifting of funds from hospitals into the community and helping to impose a stringent and bureaucratic set of standards on dermatology GPSIs.

But the BAD has been at its most effective – and for GPs, most infuriating – in its attempts to drastically cut the number of GPs who are considered qualified to take part in minor surgery. Until now it has managed to persuade many PCTs they would not be doing their jobs unless they stopped part-time GP surgeons from doing theirs – despite the benefits, and patient satisfaction, that GP operations have brought.

GP minor surgery has been under pressure ever since publication of the 2006 NICE skin cancer guidance, which has become emblematic of the institute's failure to properly engage with general practice. But although the NICE guidance did, for the first time, propose that GPSIs operating on skin tumours should be members of multidisciplinary teams, it did not make any attempt to extend that recommendation to all GP surgeons. It's a testament to the lobbying powers of the BAD that a far broader and more prescriptive interpretation has become so widely accepted. The dermatologists have somehow managed to argue that no GP should be doing any surgery that could inadvertently remove a skin tumour unless they possess the full GPSI level of accreditation.

Against that backdrop, the recent crunch meeting of the BAD, GPC, RCGP and NICE was critically important. In the attendants' hands was not only the future of GP minor surgery, but also the wider health economy. Professor Steve Field, the college's chair and not a man given to hyperbole, had warned that the NHS would ‘grind to a halt' if all operations currently done in primary care were suddenly shifted to hospital. As Pulse reports this week, the GP representatives secured a key concession, with clarification that NICE does not want the requirements specified in its guidance applied to every GP surgeon in the country. That's a huge boost to general practice, and avoids a nightmare scenario of backed-up referrals and mass loss of income. But it is premature to sit back, relax and assume the war has been won.

The BAD has deployed phrases such as quality and patient safety as weapons in the scrap over minor surgery and until now has been highly effective at turning the heads of PCTs. The GPC and the college cannot rely on NICE to win trusts round to the new position. They must promote the quality and cost-effectiveness of GP surgery, and trumpet the institute's endorsement of their position. It's time PCTs stopped seeing primary care surgery as second-rate.


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