GPs slam revised version of NICE skin cancer guideline

26 Nov 09

The chair of the Primary Care Dermatology Society said the draft guideline was a major threat to the practice of minor surgery in primary care and claimed NICE had gone back on an agreement to relax its guidance.

NICE agreed to look at its 2006 skin cancer guideline again after protests from the RCGP and GPC that it was too restrictive and prevented GPs from removing most basal cell carcinomas without consulting a dermatologist.

Pulse exclusively revealed in May that following a heated meeting with the RCGP, BMA and the British Association of Dermatologists, NICE had agreed to a series of concessions.

Dr Stephen Kownacki, chair of the Primary Care Dermatology Society, said NICE had agreed to loosen the definition of a ‘high-risk’ basal call carcinoma to just those on the ears, eyes and nose, mouth and more than one centimetre on the face at this meeting so GPs and GPSIs could continue to conduct minor surgery independently, but this had not happened.

The new draft guideline – published by NICE this week – does allow GPSIs and GPs already performing skin surgery to remove low-risk BCCs if they can satisfy their PCT they are competent, but the definitions of ‘high risk’ remains largely the same.

'GPs already excising BCCs should provide evidence that they have been excising low-risk BCCs appropriately with adequate skin margins. If the GP cannot provide such evidence, they should undergo a direct observation of procedural skills.

'Patients with clinically suspected or histologically confirmed high-risk BCCs should continue to be referred to approved specialists,' the guidance reads.

Dr Kownacki said the draft guideline had angered his members as it meant they would have to refer most carcinomas on to secondary care.

‘We have members spitting blood over this. We are now going back to send a list of every pigmented lesion or any possible risk swamping secondary care.

‘Of course secondary care see this as their saviour, if they have got to do it then people have to find the money,’ he said.

‘Is the whole GPSI development to be emasculated because of the inadequacies of a few rogue GPs doing occasional cases?

‘We look for significant simplification and a sensible definition of high and low risk BCCs such as was agreed and then rescinded at NICE earlier this autumn,’ he said.

A spokesperson from NICE said they had listened to the concerns of stakeholders and they welcomed any comments on the draft guidelines as part of the consultation before 21 December.

'We have taken into account the fact that the management of skin conditions in general is an important part of all GPs’ workload, for which they are trained, and that all GPs may undertake some minor procedures - such as curettage, cryotherapy and electrocautery - within their basic contract, and some GPs also carry out ‘minor surgery’,' he said.