Minor surgery is a well-established part of general practice, but its safety has been questioned in recent years, with some studies claiming that the quality of minor surgery is not as high as that carried out in hospital.
A major trial from 2008 – entitled The Minor Surgery Trial In the Community – concluded that minor surgery in primary care was ‘not safe as it is currently practised’.
Its authors also raised questions on GPs’ abilities to recognise malignant skin lesions or excise them correctly.
GP minor surgery
These procedures for possibly malignant skin lesions such as melanomas and carcinomas are widely performed in general practice.
Using self-reported data collated by the Health and Social Care Information Centre (HSCIC), research published in the British Journal of General Practice (BJGP) analysed results from over 6,000 GP minor surgery procedures.
GPs were classified as working in one of three settings – those carrying out minor surgery in their own practices as an enhanced service, GPSIs who have extended surgical and dermatology training and work independently and GPs working under acute NHS trust governance.
Data were collected on whether correct diagnoses were made, how many samples were sent to histology and completeness of excisions made.
They found that the great majority (89%) of excised specimens were sent for histological examination, GPs’ clinical diagnosis was correct in 95% of cases and lesions were completely excised in 96% of cases.
The results suggested that GPs working within a managed framework performed slightly better. The researchers added that consideration needs to be given on how to better support less well-supervised GPs, possibly by establishing a minor surgery register.
Minor surgery has further benefits for patients in that it is convenient and often has lower waiting times.
The researchers said: 'The Minor Surgery Trial In the Community carried out in 2008 reported that, although patients were more satisfied with the greater convenience of GP practice-based minor surgery, there were questions about GPs’ ability to recognise malignant lesions or excise them correctly.
'This audit reports how contemporary GP surgeons send 89% of specimens to histology and that 95% of the GP predictions that a lesion was malignant were correct; with 96% completely excised. There was a gradation in quality between GPs working under enhanced services provision within their own practice, who did less well across a range of indicators, than GPs with a special interest and GPs working under acute trust governance.
'A GP minor surgery register, with the data collection acting as a surgical checklist, might improve quality and allow audit of clinical standards.'