'Cock-eyed' minor surgery tariff forces GPs to drop complex work

Sophisticated minor surgery work is not financially viable in primary care because of the standardised fee GP practices receive for a wide range of procedures, a dermatology expert has warned.

Minor surgery: GPs warn fixed tariff means simple and complex work attracts same fee (photo: SPL)
Minor surgery: GPs warn fixed tariff means simple and complex work attracts same fee (photo: SPL)

Dr Brian Malcolm, associate specialist and GPSI in dermatology in Devon, said the standard £87.01 DES tariff covering invasive minor surgery gave GPs little financial incentive to offer more sophisticated excisions and should be renegotiated.

He called for a more refined system of payments based on the difficulty of excision to encourage more GPs to offer services in the community.

The GPC said practices should lobby their PCT to change the tariff and consider dropping out of enhanced services if they are not offered cost-effective pricing.

It comes after the RCGP said restrictions on GP minor surgery have cut practice income by up to £32,400 a year, damaged the profession's skill base and wasted millions of pounds of NHS cash.

Dr Malcolm said: 'The minor surgery national tariff is paid to me whether I work on a skin tag or do a small skin biopsy - not even treating it - yet it's the same for a carefully dissected out scalp lesion. The same money!

'The tariff is antiquated. It should be much more broken down into levels. We cannot make money out of excising a simple basal cell carcinoma (BCC) on the trunk.'

He argued the range and sophistication of equipment required for more complicated procedures makes the business case difficult under the current system. 'I never book anything that takes more than 10, maybe 20 minutes, otherwise I'm subsidising the NHS,' he said.

'With my GP business hat on, drilling down into the figures, we have to ask - is it worth doing? Does it make financial sense?'

Dr Malcolm said the current system to accredit GPs to perform minor surgery is 'cock-eyed', and called for a new national scheme. At present, PCTs run different schemes meaning GPs often cannot use their accreditation even in the neighbouring region, he said.

Many GPs are also struggling to get accredited during the 'limbo' as PCTs are dismantled and clinical commissioning groups (CCGs) established, said Dr Malcolm.

GPC deputy chairman Dr Richard Vautrey said practices should lobby their PCT on the issue.

'In the current climate with soaring expenses and falling pay practices need to consider carefully the costs of doing any enhanced service and if it is not cost-effective seriously consider whether they should stop this work until the PCT, and the CCG in the future, offers a more realistic pricing structure.'

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