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

Botting, Jonathan; Correa, Ana; Duffy, James D.; Jones, Simon A.; Lusignan, Simon de

doi:10.3399/bjgp16x684397

Cited by 11 publications

(37 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In studies from both the UK [11] and Ireland [12], the outcomes for primary excision of malignant melanoma were shown to be equivalent between GP and hospital providers. A community-based surgery audit from the UK, which examined 6138 procedures, concluded that GP minor surgery was safe and prompt and that GPs working within a managed framework performed better than less well-supported GPs [13].…”

Section: Introductionmentioning

confidence: 99%

Minor surgery in general practice in Ireland- a report of workload and safety

Riain¹,

Maguire²,

Collins³

2020

BMC Fam Pract

View full text Add to dashboard Cite

Background: The provision of minor surgical services is an established part of the task profile of general practitioners (GPs) in many countries in Europe and elsewhere. This study aimed to collect data on the clinical process and outcomes for specified minor surgical procedures undertaken in Irish general practice by GPs experienced in minor surgery in order to document the scope and safety of minor surgery being undertaken. Methods: Over a six-month period, 24 GPs in 20 practices recorded data on a predetermined list of procedures undertaken in adults (aged 18 and older); procedures for ingrown toenails were also recorded for those aged 12-18 years. Clinical data were rendered fully anonymous by the participating GPs, entered onto the Excel database template and returned to the project team monthly. Results: On average, each practice undertook 212 procedures in a six-month period. The four most frequent procedures include two relatively non-invasive procedures (cryosurgical ablation of skin lesions and aspiration and/ or injection of joints) and two more invasive procedures (full thickness excision of skin lesion and shave, punch or incisional biopsy). Overall, 83.8% of relevant specimens were submitted for histology. Combining benign and malignant cases, there was an overall 87% clinical and histological concordance; 85% of malignancies were suspected clinically. A complication was recorded in 0.9% after 1 month. Conclusions: Irish GPs with experience in minor surgery can provide a range of surgical services in the community safely.

show abstract

Section: Introductionmentioning

confidence: 99%

Minor surgery in general practice in Ireland- a report of workload and safety

Riain¹,

Maguire²,

Collins³

2020

BMC Fam Pract

View full text Add to dashboard Cite

show abstract

“…In a self-reported study from volunteer GPs doing local anaesthetic skin lesion excisions, 5 6138 procedures were analysed, of which 926 were confirmed as malignancies, including 722 BCCs. Model 2 GPs and GPwSIs had statistically significantly higher rates of complete excision than ESGPs.…”

Section: Introductionmentioning

confidence: 99%

High-risk basal cell carcinoma excision in primary care: a retrospective observational study of compliance with NICE guidance

et al. 2018

View full text Add to dashboard Cite

ObjectivesTo assess compliance with 2010 National Institute for Health and Care Excellence (NICE) guidance on cancer services relating to the management of basal cell carcinomas (BCC) in the community, where except in specific circumstances it is recommended that only low-risk BCCs should be excised routinely.Design and settingA retrospective observational study of the histopathology reports of BCC excisions received from primary care in two district general hospitals in the South of England. One hundred consecutive BCC excisions were analysed from each hospital.Outcome measuresThe numbers of high-risk BCCs excised in primary care according to histological subtype, anatomical site and age and if these excisions were compliant with NICE 2010 guidance. Completeness of excision and mention of BCC on histology request were secondary outcomes.ResultsHistologically high-risk subtypes were present in 32% (64/200) of BCCs excised in the community. Only 17/64 were excised by general practitioners (GPs) who were accredited to do so. Non-compliance regarding anatomical site occurred in 16% of samples; only one was non-compliant regarding patient age. There was a high overall rate of complete excision (94.5%) with variation in presence of the term BCC on histology request forms.ConclusionsNICE 2010 guidance relating to BCC excision in primary care was not followed in a considerable number of cases. Compliance with NICE 2010 guidance depends on the ability to recognise high-risk BCCs clinically and manage appropriately. It also shows that despite close supervision by secondary care, there are still failures of compliance.GP training in identification of subtypes of BCC might be improved, as well as an increase in numbers of GPs accredited to carry out high-risk BCC excisions. Difficulty in diagnosing high-risk histological subtypes of BCC preoperatively should be considered in any future revision of NICE guidance.

show abstract

“…There is limited evidence assessing specifically whether GPs with a degree of skin surgery specialism or frequency of practice have superior excision performance. Furthermore, although secondary care may have superior excision rates, suggesting that this is the optimal location for skin cancer management, this does not take into consideration patient preference . Were specific characteristics predictive of improved GP surgical performance to be identified, these might be used to guide policy development and improve the care of patients with NMSC.…”

mentioning

confidence: 99%

Factors influencing skin cancer excision rates in Scottish primary care

Korgul

Holme

2018

Clin Exp Dermatol

View full text Add to dashboard Cite

Skin cancer incidence rates are rising in the UK, yet many areas are experiencing a shortage of dermatologists. We sought to compare skin cancer excision rates between general practice (GP) surgeons to identify factors associated with good practice, through a retrospective analysis of GP skin cancer histopathology reports in three Scottish Health Boards over a 4-year period. Postal questionnaires were used to explore factors affecting surgeons' excision rates. GPs excised 895 skin cancers (4.5% of the 19 853 regional total) during the period. Of the basal cell carcinomas, 308 would be classified as low-risk by current National Institute for Health and Care Excellence criteria. Of the returned questionnaires, 58 accounted for 631 (70.5%) of the excised skin cancers. Analysing completeness of skin cancer excision, there was a statistically significant difference between GPs performing excision on ≥ 11 lesions/month compared with those performing excision on ≤ 10/month. Policymakers may wish to consider systems to facilitate low-risk patients being treated by GPs who undertake frequent surgical procedures.

show abstract

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

Abstract: Background

Cited by 11 publications

References 10 publications

Minor surgery in general practice in Ireland- a report of workload and safety

Minor surgery in general practice in Ireland- a report of workload and safety

High-risk basal cell carcinoma excision in primary care: a retrospective observational study of compliance with NICE guidance

Factors influencing skin cancer excision rates in Scottish primary care

Contact Info

Product

Resources

About