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Victory for thousands of GPs in minor surgery row

By Lilian Anekwe

Exclusive: Thousands of GPs are set for the green light to continue doing minor surgery after GP leaders won a key victory in their long-running battle with dermatologists, Pulse has learned.

GPC and RCGP representatives thrashed out a compromise with the British Association of Dermatologists over interpretation of the hugely controversial NICE skin cancer guidelines at a crunch meeting last month.

The deal will free ordinary GPs who do minor surgery from the need to meet the stringent competence requirements need-ed for dermatology GPSIs.

GPs at the meeting had to fight off a series of aggressive demands from the BAD, which wanted every GP doing any skin surgery to attend multidisciplinary meetings and submit case logs. It also insisted all GPs doing skin surgery would have to do at least 40 procedures a year to demonstrate their competence, according to a source with knowledge of the meeting.

But NICE rejected the BAD proposals, after vigorous pro-tests by GPC chair Dr Laurence Buckman, RCGP chair Professor Steve Field and several leading GPSIs in dermatology who also attended the meeting.

GPSIs in dermatology and GP surgeons who excise basal cell carcinomas as a matter of course will still be required to attend multidisciplinary team meetings and perform at least one session a week, as originally recommended by NICE.

But the key concession will mean ordinary GP surgeons can continue performing operations in the community without meeting GPSI-level standards.

It is the culmination of a protracted battle over interpretation of the NICE skin cancer guidance, with some PCTs imposing a blanket ban on GPs doing even routine procedures that could involve inadvertent removal of a skin tumour.

The institute's 2006 guidance states that any GP who has had ‘appropriate training' can manage precancerous lesions, but bars GP surgeons from excising low-risk BCCs without secondary care support.

Dr Buckman said the meeting had ‘sorted out the confusion', which had put many GPs in conflict with PCT policies.

‘The current guidelines are very rigid and have been interpreted by some PCTs to mean every GP who does minor surgery would have to conform to a set of rules that would mean stopping minor surgery.

‘When you've got that level of confusion, it's something that's got to be sorted and that's exactly what happened.'

BAD president Dr Mark Goodfield said he was ‘reassured' that there would be no redrawing of the rules for those treating patients with ‘significant skin disease'.

He added: ‘Patients with skin cancer must still be managed by doctors who have shown they have the appropriate skills.'

Dr Joe Devlin, a GP surgeon in Londonderry, Northern Ireland, said the clarifications were long overdue: ‘Minor surgery is an integral part of primary care, so NICE has to be sensible. We needed clarity on who needs which qualifications.'

Dr Goodfield added: 'The British Association of Dermatologists has never expressed concerns over GPs conducting routine skin surgery – our sole involvement in this issue has been explicitly in relation to the quality of care of skin cancer patients. We stand firm on wanting the best quality of care for skin cancer patients but have never made any "aggressive demands" – we simply aim to ensure that any practitioners wishing to treat skin cancer meet the accreditation guidelines, which have not changed in any way as a result of this meeting.'

Dr Joe Devlin: clarification long overdue Dr Joe Devlin: clarification long overdue

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