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Revealed: Why NICE agreed to review skin cancer guidance

By Lilian Anekwe

NICE finally agreed to review its guidance on skin cancer over fears thousands of minor operations in primary care would grind to a halt, Pulse can reveal.

After intense lobbying and pressure from GPs, NICE announced last week it will convene a group to formally review the guidance on minor skin surgery, in a bid to clarify the ‘unnecessarily onerous' requirements placed on GPs excising basal cell carcinomas (BCCs).

And NICE will now look to iron out the aspects of the current guidance which are preventing GPs from performing minor surgery in primary care.

Dr Fergus Macbeth, director of the national collaborating centre for cancer which will review the guidance, told Pulse: ‘We don't have any beef with GPs doing minor surgery. There are process by which GPs can do minor surgery and we don't want to interfere with that. If the way this is being dealt with is having an effect on minor surgery generally that needs addressing because that was not the purpose or the intention of the guidance.

‘There was a view expressed at the meeting and after that the guidance was causing problems in implementation. Some GPs also felt the requirements were too demanding. It becomes clear that the definition of high risk and low risk basal cell carcinomas is an issue that needs to be sorted out and resolved.'

Dr Macbeth insisted the clarifications will be issued ‘relatively rapidly' and that final advice will be available at the end of the autumn.

Opinions differ on the agreements made at the meeting, held by NICE in April, to discuss GP minor surgery. The British Association of Dermatologists insists NICE had agreed to leave the guidance unchanged and has accused NICE of a ‘politically driven' u-turn.

A spokesperson told Pulse: ‘The feedback we have from others is that NICE is going to relax the guidance around the removal of BCCS and we are not happy about that.'

But Dr Stephen Kownacki, a GP in Wellingborough, Northamptonshire and chair of the primary care dermatology society, said: ‘There was general consensus that the guidance needs to be clarified and the definitions made more specific.

‘But the meeting was remarkably amicable. It has only been subsequently that there has been some disagreement and I think that's disappointing and sad.'

Dr David Chesover, a GP in Aylesford, Kent and a NICE advisor who was also present at the meeting told Pulse: ‘ There was always going to be some new guidance on BCC that would allow GPs to do more surgery. NICE could see that there was a need to change the guidance. The BAD's statement does not reflect my perception of went on in the meeting. I think the right decision was made.'

NICE agreed to review its guidance on skin cancer over fears thousands of minor operations in primary care could grind to a halt NICE agreed to review its guidance on skin cancer over fears thousands of minor operations in primary care could grind to a halt What are the contentious issues?

- The NICE 2006 guidance on skin cancer recommends that only ‘appropriately trained' GPs can manage precancerous lesions, but cannot excise low-risk skin tumours without attending local skin cancer multidisciplinary team meetings and be subject to audit

- GPs have complained that the guidance was based on flawed evidence and drafted by a predominantly secondary-care led group with little primary care involvement

- The GPC have claimed at least one PCT was forced to abandon its attempts to implement the guidance because it is so impractical

- The rigid implementation of the guidance by PCTs has forced GPs in many areas to give up minor surgery. A Pulse investigation in June showed the number of minor surgical procedures done in primary care fell from 895,000 in 2007/8 to 737,400 in 2008/9


Primary Care Dermatology seminar

What: This one day clinical seminar looks at the latest advances and best practice in GP dermatology - specifically aimed at the non-specialist GP.

When: May 13th 2010

Where: London

Next steps: Find out more and book

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