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Skin cancer criticism insulting to GPs

I am responding to your article about researchers accusing GPs of ignoring NICE skin cancer guidelines.

I am responding to your article about researchers accusing GPs of ignoring NICE skin cancer guidelines.

First, guidelines are precisely that. They are not legislation and therefore they should be interpreted in the light of local situations rather than as dogma.

If a particular GP has the facilities and skills to provide a service and meets or exceeds the other guidelines, there should be no reason why they should not provide the service.

To suggest GPs are not capable of acquiring the knowledge or skills is insulting to the profession as a whole.

If there are practitioners wishing to be included in the service who do not have the skills, it would be helpful for the local secondary care team to offer training. It would be helpful for NICE to reissue the guidelines with a supplement to this effect.

Second, I am concerned that 'research' suggesting GP skin surgery is of a lower standard than that of secondary care is being quoted as evidence, without any critical evaluation of the study.

Was this a truly blind study? Did the GPs know they were involved? What was the intention of the excision in each location? Was the patient advised that a smaller, more cosmetic excision could need revision if indicated by the histology?

Without these details the paper is not worth publication and invites ridicule. Is it just an attempt at GP bashing and public scaremongering?

If there are really significant shortcomings in management that result in problems for patients, they should be identified and corrected by education and co-operation.

From Dr John Tisdale, Truro, Cornwall

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