Primary Care minor surgery is at a cross-road. The development of predominantly consultant based treatment pathways are threatening to sideline this popular and cost-effective specialty. GPs may be forced down the road of ever less essential procedures. Alternatively, GPs can choose the route of improved standards, training and accountability. Please find below a range of minor surgery resources.
Skin cancer guidance
Guidance was developed by NICE, with input from our Clinical Champion Dr Jonathan Botting, which will allow GPs and GPwSIs with the appropriate skill base to treat low risk basal cell carcinomas (BCCs) without the need for referral to specialists.
Revised guidance and competencies for minor surgery
This guidance was developed by Dermatologists and GPs (including the RCGP Clinical Champion for Minor Surgery, Dr Jonathan Botting). As well as defining the requirements for Skin Lesion Community Cancer Clinicians (GPwSIs who provide a skin cancer surgical service) it also lays out the requirements for those providing skin surgery under LES and DES contracts. This guidance includes new recommendations and was published in April 2011.
Community-Based Surgery Audit
Minor surgery can be rewarding for GPs and their patients, but activity has been severely curtailed since the original 'Improving Outcomes Guidance for Skin Cancer' was published by NICE in 2006. At the time, a lack of evidence available from primary care meant that it was difficult to argue that GPs could provide a quality service. In order to argue for an increased role in this field we as a profession need to audit what we do and to analyze the diagnostic and surgical skills we possess. This means we need to be able to audit activity on a national scale. This will be the opportunity for GPs to build a foundation from which an accountable, affordable and high quality service can be developed. We hope to be able to match the quality of care available elsewhere in the NHS but at an affordable price.
The RCGP's Clinical Innovation and Research Center (CIRC) is pleased to have partnered with the Health and Social Care Information Centre (HSCIC) to establish such an audit system for community-based surgery in the UK. Having defined the required data set and defect-tested the system's first iteration, a second version is currently live on limited release to a restricted but broad ranging group of community-based surgical practitioners. Based on their feedback, we aim to have an audit system fit for UK-wide release in 2014.