How disappointing to read the correspondence from the British Society for Surgery of the Hand (BSSH) about carpal tunnel surgery in primary care.
The letter seems intended to stem the flow of procedures to primary care and engender fear among commissioning organisations. But the content and conclusions do not stand up to scrutiny or reflect current practice.
The BSSH states hand surgery should not take place outside a hospital and without supervision of a consultant. We take the view that some hand surgery is the domain of secondary care, where specialist skills, investigations, equipment and general anaesthesia are required, but not carpal tunnel surgery. If the GP can demonstrate good, safe clinical care they should be able to do so.
The previous government’s Care Closer to Home policy placed responsibility on PCTs to move care into the community where appropriate. It made reference to carpal tunnel surgery provision as an example of what could be done. Since then, several centres have been set up, using appropriately trained GPs.
The conclusion in the BSSH letter that the required skills for carpal tunnel surgery are ‘unlikely to be possessed by GPs or nurses’ is inexplicable – at best ill informed and at worst an insult to primary care.
GPs and specialists all attended the same medical schools but chose different routes. Some GPs wish to extend their roles. To suggest they are incapable because they are GPs beggars belief.
From Dr Raj Dhumale, King’s Lynn, Norfolk. President, Association of Surgeons in Primary Care