GPs’ skin cancer excisions

I am a GP with a special interest in skin cancer, and have been excising basal cell carcinomas (BCCs) in the community within the Oxfordshire Community Dermatology Service since 2010. My incomplete excision rate over this 4-year period is 1.7%, as is that of the GP colleague who works with me. Approximately half of the lesions we excise are on the head and neck. There are other GPs with surgical aptitude who would love to work in our service but are unable to undergo the costly (to themselves and their practices) training and accreditation process required by the National Institute of Health and Care Excellence guidelines. How can they demonstrate competence through audit data, when they are not allowed to perform the procedures in the first place? Rather than using this study¹ as evidence to implement a similar guideline in Scotland, I would encourage commissioners there to engage with GPs with surgical aptitude, get them trained to a suitable standard (in conjunction with their local dermatologist and skin cancer multidisciplinary team) and encourage their colleagues without such aptitude to refer the patients with low-risk BCCs to them.

• © British Journal of General Practice 2014