GP minor surgery is 'unviable'

Sophisticated minor surgery work is not financially viable in primary care because of the flat fee GPs receive for a wide range of procedures, a dermatology expert has said.

Surgery funding needs refining (Photograph: SPL)

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

Dr Malcolm called for a more refined system of payments so more GPs were encouraged to offer services in the community.

He said the current system for accrediting GPs to perform minor surgery was 'cock-eyed', and a new national scheme was needed.

PCTs run different schemes and GPs often cannot use their accreditation in neighbouring areas.

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

The RCGP warned last month that restrictions on GPs carrying out 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 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.'

Dr Malcolm argued that the range and sophistication of the equipment needed for more complicated procedures makes the business case difficult to justify under the current system.

'I never book anything that takes more than 10, or 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 whether it's worth doing. Does it make financial sense?'

GPC deputy chairman Dr Richard Vautrey said practices should lobby their PCTs 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, offer a more realistic pricing structure.'

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