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RCGP leader hits back at dermatologists' attack on GP minor surgery

By Lilian Anekwe

RCGP chair Professor Steve Field has defended GPs from a scathing attack by the British Association of Dermatologists' (BAD), after it reacted furiously to a decision by NICE to formally review its guidance on minor skin surgery.

The RCGP called for dermatologists to put aside political motivations and ‘work cooperatively with primary care for the good of patient care.'

On Friday NICE announced a review of its guidance on the excision of low risk basal cell carcinomas (BCCs) in primary care, acknowledging that the interpretation of the current guidance is ‘unnecessarily onerous'.

The announcement has been welcomed by GP experts, but the BAD claimed NICE had backtracked on earlier agreements in a ‘politically driven' move that threatened patient safety.

Dr Mark Goodfield, president of the British Association of Dermatologists said: ‘We feel very strongly that in the interests of patient safety, the NICE guidance should be maintained and thoroughly implemented, and not relaxed. Evidence shows that where GPs do not comply with the guidance, patient care suffers.'

A spokesperson for BAD told Pulse: ‘We were under the impression, following a meeting in April, that an agreement had been reached that the guidance was not going to be significantly changed and that a review was not necessary.

'We now have the impression that NICE are going to relax the guidance around the removal of low risk BCCs and we are not happy to hear about that.'

Professor Field admitted to being taken back the association's ‘adversarial' stance. ‘Some of the dermatologists have been rigid and that's not been helpful. I have been rather surprised at how they have come across as rather adversarial at times.

‘Now, at last, we can have a sensible debate about minor skin surgery in primary care and what we have got to do is put the individual differences aside and work for the good of patients.

'We need to take the politics out of this. The current guidance did not have enough GP input and I do believe that the guidance required changing.'

Dr David Chesover, a GP in Aylesford, Kent and a NICE advisor on interventional procedures in primary care, told Pulse: ‘The guidance needs to be reviewed because it's old, and general practice and the NHS moves so quickly that guidance that is six years old is no longer applicable. The future sustainability of minor surgery would have been in doubt had NICE not agreed to this review.

‘NICE has got to start again because the evidence on which the current guidance is bases is poor to average at best. The NHS can't afford what the dermatologists want – for all minor surgery to be done in secondary care. I think there's a good chance things will come to a sensible and reasonable outcome.'

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