Minor surgery audit to 'prove the value' of practice-based procedures

A nationwide audit of practice-based minor surgery has been launched by the RCGP in a bid to prove that GPs have the skills to diagnose and treat dermatological conditions, including skin cancers.

Biopsy procedure: the RCGP wants to prove the value of GP minor surgery (Photo: SPL)
Biopsy procedure: the RCGP wants to prove the value of GP minor surgery (Photo: SPL)

Pilots of the Community-based Surgery Audit (CBSA) will record for the first time how many GPs across the UK offer procedures including removal of skin cancers, pre-cancerous lesions and benign skin cysts.

Experts at the college hope the audit, organised with the Health and Social Care Information Centre (HSCIC), will demonstrate that GPs can provide effective care with positive treatment outcomes. It is hoped this will enable GPs to take a larger role in treating skin cancers.

The RCGP also claimed the move could save the NHS millions of pounds.

It follows criticism of GPs' ability to perform safe and effective minor surgery, which led to NICE in 2006 withdrawing support for many of the in-practice procedures GPs had once provided.

Although a 2010 update to guidelines partially restored some of these functions, since then GPs have often steered clear of the excessive rules and regulations surrounding procedures such as treating basal cell carcinomas (BCCs).

The RCGP said the CBSA gives GPs the opportunity to monitor and improve the quality of care they provide, including peer comparison. It allows GPs to collect data to support re-accreditation, appraisal, revalidation and local contracting. These will be compiled into a national database for tracking UK-wide outcomes.

Reducing pressure on secondary care

Dr Imran Rafi, chair of the RCGP Clinical Innovation and Research Centre, said: ‘It’s almost a misnomer to refer to practice-based surgery as "minor" because the implications of this kind of work are often so significant. GPs are playing an increasingly important role in the diagnosis - and removal - of skin lesions.

'Patients trust their GP and many feel more comfortable having this type of treatment at their local practice, rather than going to hospital. It’s vital that we establish how many of these procedures are taking place so that we can support more GPs to do this work - thereby reducing pressure on secondary care and specialist units.'

Dr Jonathan Botting, RCGP clinical lead for minor surgery, said: 'The CBSA is an incredibly useful tool for all GPs - providing us with a broader picture of practice-based GP surgery trends and helping us to improve patient care.'

He said around a fifth of melanomas diagnosed in the UK are first treated in primary care, even though current UK guidelines recommend referral. 'Published evidence about the quality of such treatment has been conflicting,' he said.

Dr Botting added: 'As the incidence of melanoma is doubling every 10 years, the NHS needs to support suitably skilled GPs as part of an extended, community-based, surgical network. The potential cost savings to the NHS of community-based surgery are significant.

'Our hope is that the CBSA will demonstrate that GPs have both the diagnostic and surgical skills to carry out such procedures, allowing us to take a more pivotal role in life-saving skin cancer treatments.'

The CBSA pilots are now open and detailed data will be available by March 2015.

GPs can find more information on the CBSA and sign up for the audit at the HSCIC website.

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