Community based surgery
Dr Jonathan Botting
My practice in London has provided a popular minor surgery service to our patients for decades. We now also provide minor surgery to patients registered at local practices as well as a GPwSI service. All current guidance states that audit should be part of the service provision, not only for the benefit of individual practitioners but also for commissioners and for the local cancer network. It’s all very well recording all your own activity but what does it mean and how can you use such data to support your practice? Using my role as RCGP Clinical Champion for minor surgery from 2010-2012 I brought together a team from primary care, secondary care and data specialists to come up with an answer.
If you or your practice provide any level of minor surgery to your patients then you should consider using the RCGP developed Community Based Surgery Audit (CBSA) which is free to all NHS users. Developed with the Health and Social Care Information Centre (HSCIC) this web-based tool allows every surgical procedure to be recorded in a consistent manner with simple drop-down lists and easy to use check boxes. Patient identity details are kept to a minimum (name, NHS number, date of birth and postcode) and once entered on the system as many lesions or procedures as necessary can be added to each patient. The system records the type of patient (own practice, referred etc.) along with the surgeon’s role (GP, GPwSI etc.). It records your clinical diagnosis and how that diagnosis was reached (e.g. with or without dermoscopy, specialist opinion etc.). The surgical entry is very straightforward and quick and in addition it calculates the waiting time (from referral) as well as recording how consent was obtained. It also records if a sample was sent to histology and, if not why. When the histology comes back that is simply and quickly added to the patient log and finally 2 months after the surgery any complications that may have occurred can be added to complete the surgical record.
So far this may sound like any stand alone Excel like spreadsheet, indeed the data can be downloaded at any time in spreadsheet format, but it is the added value that makes the CBSA unique. Once 3 months of completed data has been captured (plus 2 months for any complications to be reported) the system generates instantly accessible surgical reports. Not only do these record all the surgical activity (by anatomical location and lesion type) they also calculate diagnostic accuracy, surgical skill (completeness of excision) and complications. Finally and uniquely the system compares your data with all other equivalent data nationally (filtered by the surgeon's role to compare like with like).
So far national data from the first two years has recorded 926 malignancies of which 93% were completely excised, most common were Basal Cell Cancers (780 BCCs) and of those 95% were correctly diagnosed by the GP surgeon. Depending upon the GP role 89-97% of all lesions were sent to histology and complication rates overall were less than 2%.
The CBSA is encouraged by CQC and a practice using it provides them with evidence of exemplary practice. Finally GPs using the system are able to generate their own annual audit for appraisal at the click of a button. If you or your practice provide a surgical service I would encourage you to sign up today here.