GPs allowed to perform more minor surgery in-practice

GPs will be allowed to perform more minor skin surgery in their practices under updated clinical guidelines.

NICE's 2010 guidelines will be expanded to allow GPs to perform low-risk basal cell carcinoma surgery
NICE's 2010 guidelines will be expanded to allow GPs to perform low-risk basal cell carcinoma surgery

The DoH framework explains how commissioners will audit GPSIs in dermatology for competence, as well as the training required for the role.

It also incorporates NICE’s 2010 skin cancer guidance. NICE 2010 guidance allowed GPSIs to manage an expanded range of low-risk basal cell carcinomas including some on the head and neck. It was produced in response to concerns that previous guidance was restricting GP minor surgery.

Dr Jonathan Botting, RCGP clinical champion for minor surgery, helped develop the guidance. He said it would give GPs and commissioners a clear understanding of the evidence needed to demonstrate surgical competency.

‘If we wish to drive a car we need to pass a test, if we wish to be paid to insert IUDs we need to be trained and demonstrate competency,’ he said. ‘Why should taking a scalpel to a patient be any different?’

The DoH framework, the first update since 2007, includes advice relating to a new skin lesion GPSI role. NICE had proposed this role to increase the number of health professionals in primary care that are able to manage suspected skin cancer by requiring ‘less onerous’ training standards than existing skin surgery GPSIs.

Under the new framework, GPSIs will need to submit annual audit data. Their submissions need to include a review of clinical versus histological diagnosis accuracy, complication rates and a record of competency assessment.

The framework also includes a list of requirements that commissioners should consider when assessing GPs without a special interest who wish to perform minor surgery under an enhanced service.

Such GPs must demonstrate competency using appropriate means, such as direct observation of practical skills. GPs who conduct fewer than 100 procedures each year should be re-checked for competence at least every three years, the guidance says.

Such GPs must also demonstrate they have met requirements set out in the NICE skin cancer guidance, and conducted a wound infection and patient experience study.

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