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RCGP says plan for GPs to photograph lesions ‘implies doubt’ in their clinical judgement

Asking GPs to take pictures of lesions before skin cancer referrals ‘implies doubt’ in their clinical judgement, the RCGP has warned.

As Pulse reported this week, GPs in the North East of England will be required to submit photographs with any referrals for skin cancer, which will determine whether the patient should be seen by specialists.

Under the new system, GPs will have to take three photographs with their mobile phones and a dermatoscope and submit those with the referral. A consultant will then review the pictures and offer either an urgent or routine appointment, or an alternative treatment plan.

GPs have expressed concerns about the proposal, saying it could result in longer GP appointments as well as making GPs liable should dermatology decline to see these patients. 

RCGP chair Professor Helen Stokes-Lampard said the requirement for GPs to submit photographs in addition to the existing steps ‘implies doubt’ about the GP’s clinical judgement and could substantially delay the process.

She said: ‘Deaths from malignant melanoma, the most serious form of skin cancer, are increasing more than any other cancer, so identifying skin cancer at the most timely stage possible leads to better health outcomes and, potentially, saves lives.

‘However, introducing this extra step to the process of urgent referrals implies doubt about GPs’ clinical judgment and risks adding substantial delays to the process.

‘It is vital that all new initiatives are piloted carefully and appropriately funded before roll-out to ensure patient safety and prevent significant adverse impact on GP workload.’

Dr Stokes-Lampard added that skin cancer differs from other cancers as it is ‘often visible’.

She said: ‘Unlike many other cancers, skin cancer is often visible, and  better access to diagnostic tools like dermatoscopes in our practices, along with the training to use them, is welcome.

‘GPs are already doing a good job of appropriately referring patients we suspect of having cancer, but we need proper resources if we are to continue to deliver the best possible care to all our patients, both now and in the future.’

Last year, NICE urged GPs to refer more people with suspected skin cancer urgently, warning that nearly three out of 10 malignant melanomas are still being diagnosed after routine referrals to secondary care.


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