Dermatology and skin surgery FAQs

1) What is the eligibility criteria for GPwER Dermatology and Skin Surgery accreditation?

In addition to the speciality criteria the candidate must meet the following requirements:

  • provide evidence of Certificate of Completion of Training (CCT) or equivalent in general practice
  • to be actively working in General Practice and be registered on a performers list (or equivalent) 
  • undertake an annual medical (whole scope of practice) appraisal 
  • provide evidence of GMC registration  

Please also refer to the GPwER Terms and Conditions [PDF], section 2.

2) Do I need to be nationally accredited to be a GPwER in Dermatology and Skin Surgery

National Accreditation of a GPwER in Dermatology and Skin Surgery is deemed as best practice and is supported by the Royal College of General Practitioners, the British Association of Dermatologists, the Primary Care Dermatology Society, NHS England, and patient groups,  with interest from the GMC in the context of their developing credentialing proposals. There are many benefits to RCGP accreditation to the individual GPwER, which include:

  • It enables GPs to demonstrate competence against a national standard, including some GPwSIs who have not had the opportunity to accredit against national guidelines.
  • The accreditation is portable, meaning that a GP should not need to re-accredit if they move to a different geographical area.
  • In accordance with the RCGP's generic GPwER framework, GPwERs accredited through the RCGP only have to go through the process once, avoiding the need for re-accreditation.
  • GPwERs accredited through the RCGP process can act as clinical supervisors and train/mentor other GPs wanting to become a GPwER.
  • It is likely that GPwERs accredited through the new process will be better recognised by defence unions.

3) Is RCGP accreditation applicable to those delivering minor skin surgery through a Local Enhanced Service (LES) or Directed Enhanced Service (DES) contract?

There are significant differences between a GP providing a commissioned skin surgery / minor surgery service (such as under a DES or LES contract) and a GPwER:

GPs providing surgical services - manage benign skin lesions and small low-risk BCC beneath the clavicle. They are first and foremost surgical services. GPs would be expected to have an understanding of lesion recognition appropriate to their surgical remit but they have not undertaken specialist training and competency based assessment in skin lesion recognition and management. In essence, skin surgery services such as DES or LES only cover clinical remits that are within the normal scope of General Practice; as such the RCGP does not consider that such roles warrant extended role accreditation. It remains good practice to make certain that the premises used are fit for purpose, and that the GP has their surgical competencies assessed (for example using a Direct Observation of Practical Procedure assessment tool) and periodically reviews their quality of their care.

GPwERs – work as an integrated team with commissioned secondary care services. GPwERs have undertaken formal specialist training and assessment in the diagnosis (clinical and dermoscopic) of skin lesions, enabling the GPwER to be commissioned to provide skin lesion clinics (excluding 2-week waits). Groups 2 and 3 GPwER can also provide surgical services with a wider remit, which may include certain BCC on the head and neck (refer to Annex C in the 2018 RCGP framework Guidance and Competencies for GPwER – Dermatology and Skin Surgery). The remit described is broad and so formal accreditation is required.

 

4) As a Group 2 GPwER in Skin Lesion Management do I have to manage basal cell carcinomas as part of my clinical remit?

Most Group 2 GPwERs manage basal cell carcinomas as part of their clinical remit, but this is not mandatory. A few Group 2 GPwERs diagnose skin lesions but surgically only manage the benign lesions.

5) How much general practice do I need to do to be accredited as a GPwER?

The RCGP does not specify a number of sessions, but it is usually expected that a GPwER will have a good balance between their general practice commitments and their specialist role. There may be individual circumstances when the role of the GPwER dictates that a greater proportion of their work is in the specialist role.

6) As somebody seeking accreditation for the first time, can my pre-CCT clinical training count towards my accreditation?

Yes, you can use evidence from your Foundation Year 2 or, if applicable, any relevant specialty training undertaken prior to GP Specialty Training within the five years prior to accreditation.
 

7) What happens if I can't identify a local Clinical Supervisor to support my application?

An unsupported applicant refers to an individual who has no local senior clinical supervisor and so is unable to progress with accreditation. This situation may arise for a GPwSI seeking transition to GPwER status, or a first-time applicant who has not been a GPwSI. 

A senior clinical supervisor can be any of the following:

  • A consultant dermatologist
  • An RCGP accredited GPwER&
  • Another consultant working in the same scope of practice, for example a consultant plastic surgeon for Group 2 GPwERs

If there are no such individuals within a respectable commuting distance and there is real patient need to develop a local dermatology/skin surgery service, then in exceptional circumstances the RCGP may consider accreditation of a candidate by other means, for example, an associate specialist in the relevant scope of work could be considered as the senior clinical supervisor, or the use of teledermatology. Individuals in this predicament should complete the Unsupported Candidate Form [Word] and email it to the accreditation office for consideration by the GPwER panel (comprised of a GPwER, consultant dermatologist and lay member). If the panel accept the proposal then the individual can proceed with the accreditation process. The panel will not review the document unless all the relevant sections are complete.

The RCGP is unable to advise on issues where local senior clinical supervisors are unable/unwilling to support the accreditation of GPwERs. In such circumstances please contact the relevant organisations such as the Primary Care Dermatology Society and the British Association of Dermatologists.

8) Do I need a Diploma in Dermatology?

It is advantageous (especially for Groups 1 and 3 GPwERs) but not essential if you can clearly demonstrate other ways in which you have gained relevant knowledge in your extended scope of practice. There are a number of helpful learning resources including the RCGP Dermatology Educational Library, the Primary Care Dermatology Society website and the British Association of Dermatologists website
 

9) Is the RCGP 'grandfathering' GPwSIs into the new process?

No, there is no grandfathering of GPwSI. All candidates will need to demonstrate the required standard of competence, as defined by the RCGP in collaboration with the BAD and PCDS, through the submission of a portfolio of supporting information. However, the process for candidates who can demonstrate previous accreditation by a reputable body using the 2007 and 2011 guidance is very much simplified, for example candidates are required to provide a supporting statement from an appropriate clinical colleague, rather than repeat clinical assessments such as DOPS and mini-CEX.

Please refer to the 2018 Guidelines for GPwER in Dermatology and Skin Surgery [PDF] for more information.

10) Why is the process being delivered on a one-year trial basis initially?

The RCGP hasn't undertaken the accreditation of GPwERs previously, and wants to ensure that it can deliver the process on a sustainable basis before committing to the expansion of the programme. 

11) Is the RCGP generating income from the accreditation process?

No, the College's will deliver the process on a cost neutral basis. The candidate fee will be subject to regular review, and we will keep it as low as possible to cover costs.

12) Is the accreditation available to GPs outside of England?

The RCGP's Generic Framework to Support the Governance of GPs with Extended Roles and associated specialty frameworks are intended to be applicable to the four countries of the UK, and the College is committed to making its accreditation process available to all UK-based GPs, regardless of the country in which they are based or the sector in which they work. However, due to external funding conditions, the primary audience for the Dermatology and Skin Surgery accreditation trial are GPs on the NHS England performers list. However, if you are based outside of England or you do not work in the NHS and you are interested in accreditation, we would advise you to contact us so that we can explore how you might participate in the trial.

13) How much does the accreditation cost?

The accreditation costs £499, with a rate of £449 for candidates who have been previously accredited, see FAQ 9 and are eligible to submit a reduced portfolio.

14) How long does it take to become a GPwER in Dermatology and Skin Surgery?

There is no set time or required number of specialist clinics that a GP needs to partake in as part of the accreditation process. The outcome is based on competencies, and other attributes of the GPs performance that enables the GP to demonstrate that they are capable of practising autonomously in a specialist area of medicine.

15) How many patient feedback responses are required for GPwER accreditation?

For the purposes of accreditation, candidates are required to reflect on responses from 25 candidates. Further information can be found on the Patient survey guidance document [Word]

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