When the changes in minor surgery were announced to coincide with the 'new' GMS contract in 2004, our practice was quite excited.
The old 'red book' agreement that preceded it only allowed 15 patients per quarter per principal to be claimed. We had always far exceeded this, in effect, subsidising our local PCT by doing unpaid work.
The 2004 changes would allow us to develop new ways of working with a greater emphasis on local services for patients and greater flexibility. It also helped to reflect the changing workforce in general practice with more employed doctors and less principals.
This excitement was quickly defused as an immediate cap on payments was imposed by our PCT so the overall level of payment was similar to that prior to the contract changes.
Level of service
Generally practices can be divided into three groups in this field: those doing no minor surgery; those undertaking the minor surgery additional service; and those undertaking the enhanced minor surgery DES in addition.
The additional service is for the three "Cs" - cautery, cryotherapy and curettage. Practices receive a flat payment for this and the work is separate from the DES.
We use a computer-based template for recording and claiming our minor surgery. As well as recording the procedure, it includes useful prompts for example recording consent.
The template is used for all procedures, including the three 'Cs', in part due to the support the prompts give but also so we can demonstrate we are undertaking the additional service too.
Last year our cap was raised, but was still insufficient to cover the number of procedures patients requested. The dilemma remains as to whether these patients should be undertaken within the practice at a personal cost to us or referred elsewhere at a higher cost to the PCT/CCG.
Previously, while abscess incisions and many injections were undertaken at presentation, other procedures were individually booked to be completed a week or two later, often in the middle of the day. This time suited the nursing staff when they were less busy.
Following a number of successful operating list sessions, arranged specifically for training registrars, we are moving to having this as the main method of service provision.
As well as improving training, having a dedicated list facilitates good compliance with obtaining and recording consent along with generating the appropriate personally administered prescriptions for medication used.
This new system is still being established, but revolves around a number of doctors agreeing to have open lists with patients being booked directly onto these by colleagues or staff.
A flowchart was agreed to ensure only appropriate patients were booked with potentially malignant lesions or ones on the face or hands being highlighted and possibly referred elsewhere.
Now all we need to do is persuade the CCG to adequately fund the level of patient demand.
- Dr Phipps is a GP in Lincolnshire