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Minor surgery criticism is insulting

I am very disappointed by Professor John Primrose's condescending and negative views on minor surgery in primary care, which unfortunately appear to be representative of many consultant surgeons.

I am a GP with a special interest in minor surgery working in Northern Ireland. I am well accredited in minor surgery having completed RILA's minor surgery diploma.

I do regular training sessions in my local district general hospital and I have travelled to Cornwall to do some training in the excellent Probus Surgery - a minor surgery demonstrator site. It is my opinion that minor surgery is an integral part of good primary care.

Professor Primrose seems of the opinion that all surgical procedures should be carried out in hospital and that most minor surgery done in primary care is unnecessary. He quotes the MiSTIC trial, which he is an author of, as supporting these conclusions. But MiSTIC showed a primary care-based service was one-third the cost of a hospital-based service, the rate of postoperative complications was similar, wound quality was only slightly better when procedures were done in hospital and patients preferred having their procedures in the community. Professor Primrose makes much of the fact that only 67% of lesions were identified as malignant by the referring GP prior to treatment. But I suspect this sensitivity would be much lower for hospital surgeons. In any case this is more an indication of GPs' dermatology skills than their ability in minor surgery.

Minor surgery in primary care is likely to be carried out by an interested experienced GP rather than a junior SHO, as is often the case in hospital.

I feel Professor Primrose is wrong when he says there is no place for minor surgery in primary care. I think there is no room for minor surgery in secondary care.

Although it is true some GPs may not have appropriate accreditation or experience to be doing minor surgery, an experienced GPSI working in good primary care facilities is in my view far superior to hospital-based care.

From Dr Joe Devlin, Londonderry

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