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Phil Peverley: Minor surgery: my farce

I like doing minor surgery. Or rather, I used to like it.

I like doing minor surgery. Or rather, I used to like it.

I can't do it any more. Late last year, our PCT told us the budget for minor surgery had been exceeded, and no matter what our contract might say, after six months of the financial year we had done all the minor surgery they were going to fund.

In fact, as it turned out, we had exceeded our funding some time before that. Although we were not aware of it, we had been doing minor surgery at our own expense for several months. We could forget about being paid for it, and from then on, we should refer it.So we did. Where before we could ask our patients to step 10 yards down the corridor for their minor procedures, now we had to ask them to go 10 miles to Washington. (That's County Durham, not District of Columbia. Even our PCT is not quite that daft.)

Then, after an unnecessary assessment (just what did they imagine my referral letter was all about?) they could go back to Washington at a later date for the operation. That's 40 miles of travelling for a five-minute procedure. Brilliant.

This particular patient had an unsightly sebaceous cyst on her neck. Today she came to me as an urgent extra. 'I'm sorry to barge in, Doctor,' she said, and I could see she was. 'But they told me I should see you urgently.' She showed me an ECG that the nurse had taken in Washington, God knows why. I had referred her for a minor excision under local anaesthetic.

Apparently, for reasons that defy any rational explanation, she had had a full pre-op work-up. 'Yeah, right,' I said, examining the object. 'Same as the last one we did. What's the problem?' 'Apparently it's abnormal. The nurse told me to see you urgently.

'Luckily I know this patient well, so she didn't mind when I blew my top. 'Christ on a bike, we know it's abnormal! You're thyrotoxic! You're on treatment for it and you see a specialist, you're going back to see him next week!'

'I know. I told the nurse that but she said she couldn't do anything until I came to see you.'

My patient was at the mercy of this fool. All our patients are at the mercy of fools like these. Nothing gets done, no simple procedure will be performed, unless the under-qualified pillocks that are charged to perform them are covered against all possible complications, unless all responsibility for any possible side-effect is dumped at the door of someone else. And this of course means the GP.

My patient needed a cyst taking off. Instead of a quick look and a quick snip, she faced 40 miles of travelling, four appointments, and an unquantifiable amount of anxiety. The cost, in purely financial terms, would be three or four times the sum that our practice would have claimed. The cost to the credibility of our profession is incalculable. 'I'm very sorry about all this,' I told her. 'Lie on that couch.'

And then I performed a minor surgical procedure, for free, in my own time. I think that's what our PCT intended me to do all along.

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