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)
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.'

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins


Already registered?

Sign in

Follow Us:

Just published

£20 notes spread out

VAT trap for PCNs could strip millions of pounds from general practice

Tens of millions of pounds could be stripped from general practice because work carried...

Talking General Practice logo

Podcast: Is the BMA representing GPs effectively, why GPs face a pension tax hit, and views on the workload crisis

In our regular news review the team discusses representation of GPs, a new survey...

Man sleeping

NICE guidance on insomnia backs app to replace sleeping pills

Hundreds of thousands of people with insomnia could be offered treatment via a mobile...

Health worker prepares a dose of COVID-19 vaccine

JCVI backs autumn COVID-19 booster campaign for high-risk adults and NHS staff

Frontline health and social care staff and adults at increased risk of severe illness...

GP consultation

Government accused of 'misleading' claims on general practice workforce

GP leaders have accused the government of making misleading claims about the general...

Consulting room door

LMC calls for enhanced access to be scrapped after abuse forces practice to close reception

A Midlands LMC has backed a practice forced to close its reception desk after abuse...