Initial results from an RCGP audit of minor surgery show that GPs can carry out skin procedures successfully, with an average complete excision rate of 88-97% for skin cancers, and complication rates as low as 1-3%.
‘GPs have traditionally been accused of being poor diagnosticians and poor surgeons,’ Dr Jonathan Botting, RCGP clinical lead for minor surgery, told GP. ‘It’s early days, but what the figures show so far is that general practice surgery can be very safe and very effective.’
The audit, run in collaboration with HSCIC, has collected data on 5,000 surgical procedures since 2013 and is the largest evidence base for GP minor surgery to date.
Dr Botting hopes the audit will inform future guidance around minor surgery by providing evidence that has ‘always been missing’.
‘Thanks to NICE guidance, GPs are discouraged from treating anything other than very low-risk skin cancer work, and the data we are producing may, in time, question whether or not that is sensible or cost-effective,' he said.
NICE guidance published in 2006 meant that GPs could no longer perform minor surgery on malignant skin lesions, but following lobbying from the RCGP, low-risk basal cell carcinomas were reintroduced into primary care surgery in 2010.
‘But "low-risk" depends on who is operating, so it makes for rather a complicated arrangement for GPs,’ Dr Botting said. ‘The sadness is that the original guidance had no representation from and very little evidence from general practice – it’s what has always been missing.’
‘What we’ve tried to do is address that with the community-based surgery audit (CBSA), and give all GPs an opportunity to demonstrate the quality of their surgery.’
Despite the considerable data that the CBSA is generating, the RCGP is currently seeking funding for it to continue running. ‘There is the possibility that if we cannot secure funding, it would be put on ice,’ Dr Botting said. ‘It would be a tragedy if the project folded.’
With melanoma rates on the rise, Dr Botting believes that hospitals will struggle to deal with growing numbers of skin cancers without GP involvement. ‘There’s far too much skin cancer work in the UK for our already over-stretched hospitals to manage, and we provide an economic alternative,’ he said.
‘Instead of this lack of trust between our consultant colleagues and GPs undertaking minor surgery, we should see ourselves as part of an integrated service.’
The audit has collected data from 147 volunteer GPs, an admittedly self-selecting group, Dr Botting says – which is why more of the estimated 5,000 GPs performing minor surgery across the UK are being encouraged to contribute.
‘Ideally I would like to see every GP who’s undertaking NHS-paid minor surgery recording their data on this,’ he said. ‘It would enable them to produce comparable evidence of their own diagnostic and surgical skills, produce audit results for appraisal and revalidation, and have evidence for commissioners seeking affordable, high quality surgery.’