Under practice-based commissioning, PCTs were actively demanding that GPs took on more minor procedures.
But hospitals and dermatologists fought back, just as they did in the fundholding era, only this time they used clever guidelines that, in effect, banned all GP operations.
If the lesion was cosmetic, it could not be done on the NHS (and GPs could not charge for it privately). If the lesion was possibly cancerous, then it should not be done in primary care.
It displayed a complete misunderstanding of how difficult it is to define a benign lesion – to be safe, get it out. But there is no way that hospitals could, or should, be coping with that workload.
The new study, finding GPs do at least as well as specialists at excision of melanomas, makes sense. I am currently in Australia where GPs are expected to take off actinic keratosis, BCCs, SCCs and suspicious lesions including melanomas, and use dermoscopes – and I do all of it.
There are, of course, lesions such as BCCs and SCCs near the lips that are referred on, as are the deeper melanomas.
Cancer death rates are low in Australia, and melanoma survival is improved due to early diagnosis and a fee system encouraging GPs to operate.
The original UK guidelines were a travesty based on little or no evidence, just prejudice.
From Dr Gerard Bulger
Cairns, Australia, formerly Hertfordshire