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Victory for GPs as NICE agrees to review skin cancer guidance

By Lilian Anekwe

NICE has bowed to pressure from GPs leaders and announced they will formally review their ‘unnecessarily onerous' guidance on minor skin surgery.

In a statement today NICE acknowledged that there are ‘difficulties' caused by the implementation of its guidance on the removal of low risk basal cell carcinomas (BCCs), and have agreed to convene a group to formally review the recommendations.

The concession comes as a result of a long and intense period of lobbying by primary care leaders, who argued the guidance prevented thousands of GP surgeons from removing low risk BCCs without support and monitoring from dermatologists.

Some PCTs have already effectively abandoned using the guidance, and GPs warned the situation was driving GPs away from minor surgery and risked overwhelming secondary care with referrals.

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 designed to allow ordinary GPs surgeons to continue removing low risk BCCs.

‘Some GPs believed that the requirements, especially attendance at hospital multidisciplinary team meetings, were unnecessarily onerous and in some areas it was believed that there was a threat to GP minor surgery in general,' the statement read.

‘As a result of these concerns, NICE held a meeting in April. A number of important issues were clarified at this meeting but NICE feels that further formal review is needed.'

Dr Fergus Macbeth, director of the centre for clinical practice at NICE, said: ‘We have listened to the concerns about the difficulty of implementing the recommendations in the guidance around the diagnosis and removal of low risk BCCs in primary care.'

‘We have also 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'.'

Dr Macbeth added the guidance on suspected malignant melanoma, squamous cell carcinomas or high risk BCCs would not change.

GPC chair Dr Laurence Buckman said: 'We welcome NICE's review of its skin cancer guidance and hope that it will properly evaluate the important contribution played by GPs in treating skin cancer.

'Many patients find minor surgery in their local GP surgery more convenient and less stressful than treatment in hospitals. The requirement in the original guidance for GPs to attend multidisciplinary team meetings in hospitals threatened the viability of minor surgery services.'

NICE has agreed to review its skin cancer guidance NICE has agreed to review its skin cancer guidance

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