NICE gives reprieve to skin GPSIs

England's skin cancer epidemic, already delivering a probable 60,000 basal cell carcinomas (BCCs) a year, is set to increase for 15 to 20 more years.

Dermatology GPSIs can now treat an expanded list of low-risk basal cell carcinomas on the head (Photograph: SPL)
Dermatology GPSIs can now treat an expanded list of low-risk basal cell carcinomas on the head (Photograph: SPL)

So it was galling that updated NICE guidance due out this month threatened to limit the BCCs that primary care dermatologists could safely treat.

When NICE announced last summer that it was updating guidance on managing low-risk BCCs in the community, GP dermatologists were expecting a less restrictive definition of a 'high-risk' BCC.

This was the first time that NICE had replaced published cancer guidance and hopes were high.

Initial draft guidance appeared to dash primary care dermatologists' hopes. But the final draft, due for publication on 25 May, shows that they can treat an expanded list of BCCs.

Key changes
The guidance brings in some key changes. Dermatology and skin surgery GPSIs, who have a link with an acute trust clinical governance framework, will be allowed to treat 'the full range of skin cancers', so long as the case has gone to a core member of a multidisciplinary team.

To help cope with the epidemic, a brand-new breed of skin cancer GPSI has also been proposed.

The new skin lesion and skin surgery GPSIs and other dermatology GPSIs can also treat an expanded list of low-risk BCCs on the head and neck, so long as they avoid high-risk areas and groups of patients.

Primary Care Dermatology Society (PCDS) trustee Dr Stephen Hayes explains: 'Our main concern was that very experienced GPSIs, myself included, who remove small head and neck lesions, know their limits and work with a consultant mentor, could treat some on the head and neck.

'Some people wanted to say none on the head or neck, ever. We respect the views of people who have seen inadequately treated BCCs come back two years later with spread.'

Imposing a restricted list
But imposing a restricted list 'could possibly have closed every community skin cancer service in the country', Dr Hayes says. 'We believe that has been averted.'

The expanded list is to include 'small, well-defined BCCs located on the head or neck far enough from critical anatomical sites such as the nose and lips that they can be safely removed and primarily closed', Dr Hayes says.

GPs working under enhanced services can only remove BCCs from the trunk or limbs.

Dr Jonathan Botting, RCGP national clinical champion for minor surgery, says GPs working under an enhanced service will now have to show they have the necessary skills using direct observation of procedural skills.

This aspect of the new guidance has training and service implications but these may not be as bad as it initially appears, says Dr Stephen Kownacki, executive chairman of the PCDS.

'The GPs operating under a directed or local enhanced service will be few in number since the requirements are almost as tough as those for model 1 practitioners (dermatology GPSIs).'

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