Dermatology and skin surgery FAQs

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  
• to have undertaken at least 40 core (undifferentiated) general practice sessions in the 12 months prior to application (please contact the team if you wish to apply for accreditation but are unable to meet this requirement)

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

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.

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.

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.

The RCGP's position is that a GPwER is first and foremost a GP with a UK licence to practise, and practising in a primary care role. Such GPs bring important additional skills in practising holistically and dealing with complexity and uncertainty to extended roles. Therefore, for the purposes of accreditation, the candidate is required to demonstrate they have undertaken at least 40 core (undifferentiated) GP sessions in the 12 months leading up to accreditation. The figure of 40 sessions has been chosen because it is recognised by the RCGP, BMA and NHS England as a threshold for a low volume of work. The RCGP recognises there are exceptional circumstances and therefore if a GP wishes to apply for accreditation but can't meet this requirement, they are encouraged to contact the GPwER office to discuss their particular circumstances.

We suggest that in the first instance you approach your nearby dermatology services (hospital and/or community) to ask if they are willing to take you on and support your dermatology training. You can also contact your Clinical Commissioning Group, or equivalent in devolved countries, to find out if there are any existing GPwER services in your locality, or plans to develop such services.

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.

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.

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.

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]