Funding cuts threaten groundbreaking GP minor surgery audit

A groundbreaking audit that proved the safety of minor surgery in general practice faces being wound up in a move that GPs fear could undermine the evidence base for transferring work out of hospitals.

Basal cell carcinoma (Photo: iStock)
Basal cell carcinoma (Photo: iStock)

The Community-Based Surgery Audit (CBSA), which began as a joint project run by the RCGP and the Health and Social Care Information Centre (HSCIC), has gathered more than 8,000 submissions of data on minor surgical procedures in community settings from 160 volunteer GPs since 2013.

But the CBSA now faces being wound up after the HSCIC and RCGP warned they had been unable to secure funding to maintain it.

Findings from the audit show that GPs carried out skin procedures with high success rates - with complete excision of malignancies in 93% of cases, 95% accurate diagnoses for basal cell carcinomas and just a 2% rate of complications.

RCGP experts have said that evidence gathered through the audit could help extend the range of skin cancers that GPs offering minor surgery can treat.

The profession has faced a battle to be allowed to treat skin cancers, with NICE guidance in 2006 ruling GPs out of treating malignant skin lesions. GP minor surgeons have been able to operate on 'low risk' basal cell carcinomas since 2010 after lobbying from the RCGP.

GP minor surgery

Dr Jonathan Botting, RCGP clinical lead for minor surgery, said of the CBSA: 'This is a unique audit tool that provides confidence for patients that their surgeon is safe and effective, provides commissioners the evidence for high-quality commissioning and gives individual GPs evidence they need for appraisal, revalidation and accreditation. We are pursuing every avenue in a last-minute attempt to avoid losing this priceless resource.'

The CBSA has received praise from across the health sector, with the CQC highlighting it as an example of outstanding practice, and personal support from health secretary Jeremy Hunt. The CBSA is also being considered for use by NICE in the development of its new quality standards for skin cancer care.

GPs with additional training, such as those with special interest and those working under their local acute trusts, were shown by the CBSA to have comparable level of diagnostic and surgical skill to their secondary care colleagues. Complete excisions of all skin cancers exceeded 97% in these GPs.

However, an HSCIC spokeswoman said: ‘The HSCIC and the RCGP have worked together to maintain the audit and seek funding for over a year now. Unfortunately neither we nor the RCGP have been able to find another source of funding which is why it is coming to an end.’

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