NICE 'forcing GPs to quit minor surgery'
By Lilian Anekwe
The GPC has demanded NICE withdraw its guidance on skin cancer, which it says is forcing GPs out of minor surgery and proving ‘unworkable' for PCTs.
GPC chair Dr Laurence Buckman claims at least one PCT abandoned early attempts to implement the guidance because of collapsing confidence in it.
The warning – revealed in correspondence with NICE obtained under the Freedom of Information Act – comes amid growing evidence that GPs are giving up minor surgery in a move that may be fuelling a recent leap in referrals.
Dr Buckman, in correspondence obtained by Pulse with NICE chief executive Andrew Dillon, highlights the GPC's ‘serious concerns' about the institute's 2006 guidance on skin cancer.
The guidance precludes GPs from excising even low risk basal cell carcinomas, a recommendation the GPC feels is ‘out of proportion to the condition being treated and threatens to halt most minor surgery in primary care'.
‘The area of greatest concern is relates to the impact on primary care minor surgery. We would like to ask that serious consideration is given to withdrawing the guidance and then republishing after the full implications within primary care have been evaluated.'
The GPC has been inundated with complaints from LMCs about PCTs' draconian interpretation of the guidance and the problems its botched implementation has caused.
An attempt to introduce it early by Eastern and Coastal Kent PCT ended when the PCT wrote to GPs advising them it was withdrawing the guidance due to it being ‘unworkable in the current format'.
But NICE has ruled out withdrawing the guidance or re-consulting on it in the light of the complaints, despite admitted there have been problems with its implementation.
‘The guidance was developed in a rigorous and transparent way, with full consultation. There may be local difficulties in implementing this particular aspect of the guidance but this does not mean it should be withdrawn,' Mr Dillon wrote.
But the guidance is threatening to turn GPSI away from minor surgery en masse.
Dr John Ribchester, a GP surgeon in Whitstable, Kent, said several of his colleagues had grown increasingly frustrated at administrative demands placed on them, and were considering giving up minor surgery.
‘When GPSIs were set up it was a good idea, but it has been swamped in bureaucracy. It's a terrible shame.
‘The insistence we have to shadow a consultant and attend X amount of multi-disciplinary team meetings a year – it's a nonsense. It's a waste of consultants' time and ours. I know one GPSI who has given up and several more who are thinking about it.'There is growing evidence of GPs giving up minor surgery There is growing evidence of GPs giving up minor surgery