Row as trial casts doubt over quality of GP minor surgery
By Rob Finch
GP minor surgery has been branded ‘unsafe' by researchers on a key NHS-funded trial.
The Health Technology Assessment found operations conducted in primary care were of poorer quality, and were less cost-effective, than those done in hospital.
The research – which examined 637 dermatological procedures and 17 operations on ingrowing toenails – has fuelled a growing row between GPs and specialists over whether GPSIs should be able to take on surgical work.
GPC leaders have written to NICE to protest at the way its skin cancer guidelines – which reached a similar conclusion to the new HTA – are being interpreted by PCTs.
But the researchers were bold in their interpretation of the findings. ‘It must be concluded that it is unsafe to leave minor surgery in the hands of doctors who have never been trained to do it,' they concluded.
Operations in primary care were much cheaper than in hospital, costing just £450, compared with £1,222. But hospital-based operations were judged more cost-effective, because outcomes were superior.
Hospital doctors scored significantly higher than GPs on the 100-point visual analogue scale, by 5.5 points. They completely excised 15 of 20 skin malignancies, whereas GPs did so in seven out of 16 – a difference that ‘approached significance'.
The trial researchers, who compared operations carried out by 65 GPs and 60 hospital doctors in the south of England, also found ‘clear deficiencies in GPs' ability to recognise malignant lesions', with about one-third missed.
Study co-author Professor John Primrose, professor of surgery at Southampton General Hospital, warned it was ‘hard to accept a second-best approach'.
‘The consequences of put-ting a melanoma in the bin, which we conclude must happen, are utterly inexcusable. The cost is not the issue here. It's patient safety,' professor Primrose said.
He recommended that GPs send all tissue excised to histology, in case it proved to be malignant.
Dr David Shuttleworth, clinical vice president of the British Association of Dermatologists, went further, claiming: ‘There's a massive gulf between the two groups.'
But GPC chair Dr Laurence Buckman told Pulse he had written to NICE asking it to reinterpret its skin cancer guidance, which he said some PCTs were implementing in a ‘draconian' way.
‘The NICE guidelines, if interpreted in one way, make it impossible for GPs to operate if there's the remotest possibility of malignancy. We believe the guidelines were unintentionally created that way and are encouraging NICE to reinterpret them in line with reality.'
Dr Jonathan Heatley, a GPSI in dermatology in Horsham, West Sussex, said GPs saw many trivial cases that hospitals could not manage.
‘Hospitals couldn't cope with the workload if we weren't there,' he said.