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Patients will lose out if NICE stops GPs doing minor ops

Thank you for covering such an important issue in the story on minor surgery.

I'm a GP in Derby and a hospital practitioner in dermatology at the local hospital. I also have the diploma in practical dermatology from Cardiff and am a tutor and examiner on the course. I'd strongly recommend it to anyone.

For 18 months I have tried and failed to obtain approval for skin cancer work at the practice - largely because of the NICE guidance.

I have pleaded with the PCT, the local commissioning group, the SHA and the local cancer network - all to no avail. They think I'm a nuisance.

I still receive letters from the cancer centre telling me I have removed such and such a lesion and asking me to please not do it again. They then report me to the local clinical governance adviser.

The last one was for a basal cell carcinoma on a frail 92-year-old. At least the family and patient were grateful for my care. The local consultants are a great bunch and try to help. But getting approval cannot be done. Period.

Fortunately - if my consultants feel it is appropriate - they place my patients on my operating list at the hospital. Of the last 13 lesions I sent to the hospital, nine of them went on to my list. It's good for patient continuity, and it keeps me on my toes. Saves me my time and expense at the surgery.

But the NICE guidelines are simply unworkable.

The focus should be on raising standards by encouraging and educating those in primary care with regard to skin cancer. The problem is not the surgery itself but having the clinical skills needed to recognise what one is removing. Stopping the actual cutting will only deskill those in primary care.

GPs are still the starting point for medical care in the UK, not the hospitals. If NICE wants to write similar guidelines for every medical specialty that will be fine. But it will be the end of general practice.

Perhaps the institute thinks the medical system in the US is better? The choice lies with NICE. It is making a mistake.

Dr John Charlton, Derby

I have been treating basal cell carcinomas successfully for 20 years in my practice and am not planning to change what I do because of NICE guidelines.

We are professionals and as such have a duty to perform within our levels of competence irrespective of the latest pronouncements.

I suspect that many, if not most, of those who produce such guidelines are driven by self-importance and a need to get away from clinical work as they find it too demanding. Writing guidelines satisfies their needs and provides sticks for politicians and lawyers to try to beat us with.

Our GP registrars are getting more and more terrified of thinking for themselves or learning new skills and the future for our patients will be bleak indeed if we don't resist such commands from on high.

Dr Steve Gardiner, Dundee

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