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British Journal of General Practice

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Research

Safety of community-based minor surgery performed by GPs: an audit in different settings

Jonathan Botting, Ana Correa, James Duffy, Simon Jones and Simon de Lusignan
British Journal of General Practice 2016; 66 (646): e323-e328. DOI: https://doi.org/10.3399/bjgp16X684397
Jonathan Botting
Royal College of General Practitioners, London.
Roles: GP and RCGP minor surgery clinical champion
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Ana Correa
University of Surrey, Guildford.
Roles: Research assistant
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James Duffy
Health and Social Care Information Centre, Leeds.
Roles: Audit manager
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Simon Jones
University of Surrey, Guildford.
Roles: Research professor
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Simon de Lusignan
University of Surrey, Guildford, and director of the RCGP Research and Surveillance Centre, Royal College of General Practitioners, London.
Roles: Professor of primary care and clinical informatics
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Abstract

Background Minor surgery is a well-established part of family practice, but its safety and cost-effectiveness have been called into question.

Aim To audit the performance of GP minor surgeons in three different settings.

Design and setting A community-based surgery audit of GP minor surgery cases and outcomes from three settings: GPs who carried out minor surgery in their practice funded as enhanced (primary care) services (ESGPs); GPs with a special interest (GPwSIs) who worked independently within a healthcare organisation; and GPs working under acute trust governance (Model 2 GPs).

Method An audit form was completed by volunteer GP minor surgeons. Data were collected about areas of interest and aggregated data tables produced. Percentages were calculated with 95% confidence intervals (CIs) and significant differences across the three groups of GPs tested using the χ2 test.

Results A total of 6138 procedures were conducted, with 41% (2498; 95% CI = 39.5 to 41.9) of GP minor surgery procedures being on the head/face. Nearly all of the samples from a procedure that were expected to be sent to histology were sent (5344; 88.8%; 95% CI = 88.0 to 89.6). Malignant diagnosis was correct in 69% (33; 95% CI = 54.2 to 79.2) of cases for ESGPs, 93% (293; 95% CI = 90.1 to 95.5) for GPwSIs, and 91% (282; 95% CI = 87.2 to 93.6) for Model 2 GPs. Incomplete excision was significantly more frequent for ESGPs (17%; 9; 95% CI = 7.5 to 28.3, P<0.001). Complication rates were very low across all practitioners.

Conclusion GP minor surgery is safe and prompt. GPs working within a managed framework performed better. Consideration needs to be given on how better to support less well-supervised GPs.

  • clinical audit
  • dermatology
  • general practice
  • minor surgical procedures
  • quality improvement
  • skin neoplasm
  • Received October 14, 2015.
  • Revision requested November 2, 2015.
  • Accepted December 6, 2015.
  • © British Journal of General Practice 2016
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British Journal of General Practice: 66 (646)
British Journal of General Practice
Vol. 66, Issue 646
May 2016
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Safety of community-based minor surgery performed by GPs: an audit in different settings
Jonathan Botting, Ana Correa, James Duffy, Simon Jones, Simon de Lusignan
British Journal of General Practice 2016; 66 (646): e323-e328. DOI: 10.3399/bjgp16X684397

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Safety of community-based minor surgery performed by GPs: an audit in different settings
Jonathan Botting, Ana Correa, James Duffy, Simon Jones, Simon de Lusignan
British Journal of General Practice 2016; 66 (646): e323-e328. DOI: 10.3399/bjgp16X684397
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Keywords

  • clinical audit
  • dermatology
  • general practice
  • minor surgical procedures
  • quality improvement
  • skin neoplasm

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