Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Primary Care
Published in: BMC Primary Care 1/2020

Open Access 01-12-2020 | Skin Cancer | Research article

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

Authors: Ailís ní Riain, Niall Maguire, Claire Collins

Published in: BMC Primary Care | Issue 1/2020

Login to get access

Abstract

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 pre-determined 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.
Appendix
Available only for authorised users
Literature
1.
Boerma WG, van der Zee J, Fleming DM. Service profiles of general practitioners in Europe. European GP task profile study. Br J Gen Pract. 1997;47(421):481–6.PubMedPubMedCentral
2.
Winpenny E, Miani C, Pitchforth E, et al. Outpatient services and primary care: scoping review, substudies and international comparisons. Southampton: NIHR Journals Library; 2016.
3.
Schafer WL, Boerma WG, Spreeuwenberg P, Schellevis FG, Groenewegen PP. Two decades of change in European general practice service profiles: conditions associated with the developments in 28 countries between 1993 and 2012. Scand J Prim Health Care. 2016;34(1):97–110.PubMedPubMedCentral
4.
Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457–502.PubMedPubMedCentral
5.
Holme SA, Scott-Lang VE, Ooi ET, Matthews AG, Darling MI, Needham D, et al. The south-East Scotland dermatology workload study: 30 years' analysis. Br.J.Dermatol. 2012;167(1):123–30.PubMed
6.
Pockney P, Primrose J, George S, Jayatilleke N, Leppard B, Smith H, et al. Recognition of skin malignancy by general practitioners: observational study using data from a population-based randomised controlled trial. Br.J.Cancer. 2009;100(1):24–7.PubMedPubMedCentral
7.
George S, Pockney P, Primrose J, Smith H, Little P, Kinley H, et al. A prospective randomised comparison of minor surgery in primary and secondary care. The MiSTIC trial. Health Technol Assess. 2008;12(23):iii–iv ix-38.PubMed
8.
Neal RD, Cannings-John R, Hood K, Sowden J, Lawrence H, Jones C, et al. Excision of malignant melanomas in North Wales: effect of location and surgeon on time to diagnosis and quality of excision. Fam.Pract. 2008;25(4):221–7.PubMed
9.
Chen SC, Pennie ML, Kolm P, Warshaw EM, Weisberg EL, Brown KM, et al. Diagnosing and managing cutaneous pigmented lesions: primary care physicians versus dermatologists. J.Gen.Intern.Med. 2006;21(7):678–82.PubMedPubMedCentral
10.
Delaney EK, Duckworth L, Thompson WD, Lee AJ, Murchie P. Excising squamous cell carcinomas: comparing the performance of GPs, hospital skin specialists and other hospital specialists. Fam.Pract. 2012;29(5):541–6.PubMed
11.
Murchie P, Sinclair E, Lee AJ. Primary excision of cutaneous melanoma: does the location of excision matter. Br.J.Gen.Pract. 2011;61(583):131–4.PubMedPubMedCentral
12.
Doherty SM, Jackman LM, Kirwan JF, Dunne D, O'Connor KG, Rouse JM. Comparing initial diagnostic excision biopsy of cutaneous malignant melanoma in primary versus secondary care: a study of Irish national data. Eur.J.Gen.Pract. 2016;22(4):267–73.PubMed
13.
Botting J, Correa A, Duffy J, Jones S, de Lusignan S. Safety of community-based minor surgery performed by GPs: an audit in different settings. Br.J.Gen.Pract. 2016;66(646):e323–8.PubMedPubMedCentral
14.
O’Kelly M, Teljeur C, O’Kelly F, Ní Shuilleabháin A, O’Dowd T. Structure of General Practice in Ireland 1982 — 2015. Dublin: Irish College of General Practitioners; 2016. p. 26.
15.
National Clinical Programme in Surgery in conjunction with the Scheduled care in the SDU / NTPF. Guidance on the Appropriate Delivery Location for Different Types of Elective Ambulatory Surgery. Draft Discussion Paper, 2014.
16.
Comptroller and Auditor General. Special report number 83: Managing Elective Day Surgery. Dublin: Office of Comptroller and Auditor General, 2014.
17.
Ní Riain A, Collins C, O'Sullivan T. Developing accreditation for community based surgery: the Irish experience. Leadersh.Health.Serv.(Bradf Engl). 2018;31(1):33–46.
18.
Clarke J, Maguire N. Results of a survey of surgical experience among general practitioners in Meath. Forum. 1992;8(11):15–7.
19.
White J. Minor surgical practices of Dublin GPs. Forum. 1994;10(4):42–5.
20.
Slater D, Barrett P. Standards and datasets for reporting cancers. Dataset for the histological reporting of primary cutaneous basal cell carcinoma. London: The Royal College of Pathologists; 2019.
21.
Slater D, Walsh M. Standards and datasets for reporting cancers. In: Dataset for the histological reporting of primary invasive cutaneous squamous cell carcinoma and regional lymph nodes. London: The Royal College of Pathologists; 2019.
22.
Corwin P, Munn E, Nicholls D. A study of general practitioners' skin surgery in Canterbury. N Z Med J. 1997;110(1047):253–5.PubMed
23.
Salmon P, Mortimer N, Rademaker M, Adams L, Stanway A, Hill S. Surgical excision of skin cancer: the importance of training. Br.J.Dermatol. 2010;162(1):117–22.PubMed
24.
O'Cathain A, Brazier JE, Milner PC, Fall M. Cost effectiveness of minor surgery in general practice: a prospective comparison with hospital practice. Br.J.Gen.Pract. 1992;42(354):13–7.PubMedPubMedCentral
25.
McWilliam LJ, Knox F, Wilkinson N, Oogarah P. Performance of skin biopsies by general practitioners. BMJ. 1991;303(6811):1177–9.PubMedPubMedCentral
26.
Morrison JM, Murray TS. Survey of minor surgery in general practice in the west of Scotland. Br.J.Surg. 1993;80(2):202–4.PubMed
27.
Brown JS, Smith RR, Cantor T, Chesover D, Yearsley R. General practitioners as providers of minor surgery--a success story? Br.J.Gen.Pract. 1997;47(417):205–10.PubMedPubMedCentral
28.
Sylvester S, Magin P, Sweeney K, Morgan S, Henderson K. Procedural skills in general practice vocational training - what should be taught? Aust.Fam.Physician. 2011;40(1–2):50–4.PubMed
29.
Nothnagle M, Sicilia JM, Forman S, Fish J, Ellert W, Gebhard R, et al. Required procedural training in family medicine residency: a consensus statement. Fam.Med. 2008;40(4):248–52.PubMed
30.
Menahem S, Nazarenko A, Shvartzman P. Minor surgical procedures and musculoskeletal injections by primary care physicians - an Israeli experience. Isr J Health Policy Res. 2014;3(1):12–4015-3-12.PubMedPubMedCentral
31.
32.
33.
Gayle Stephens G. The intellectual basis of family practice. Tucson: Winter Publishing Company; 1982.
34.
Lowy A, Brazier J, Fall M, Thomas K, Jones N, Williams BT. Minor surgery by general practitioners under the 1990 contract: effects on hospital workload. BMJ. 1993;307(6901):413–7.PubMedPubMedCentral
35.
Bull AD, Silcocks PB, Start RD, Kennedy A. General practitioners, skin lesions and the new contract. J Public Health Med. 1992;14(3):300–6.PubMed
36.
O’Sullivan S, Bowe S, O’Riordan T, Murphy A, Murphy M, Heffron C, Bourke JF. Skin Cancer excisions more efficient and cost effective in a specialist secondary care service. Ir Med J. 2020;113(3):38.
37.
Taneja A, Singh PP, Tan JP, Hill DG, Connolly AB, Hill AG. Efficacy of general practitioners with specialty interests for surgical procedures. ANZ J Surg. 2015;85(5):344–8.PubMed
38.
Gérvas J, Starfield B, Violan C, Minue S. GPs with special interests: unanswered questions. Br.J.Gen.Pract. 2007;57(544):912–7.PubMedPubMedCentral
39.
40.
Alfaraj AW, Sebiany AM, Waleed A. Primary healthcare physicians’ attitude and perceived barriers regarding minor surgeries. J Health Specialties. 2015;3(2):67–73.
41.
Loveys AJ. A family doctor can do that!" is there a role for a formalized referral network for office procedures in family practices of Newfoundland and Labrador?" Electronic Thesis and Dissertation Repository; 2015.
42.
Cox NH, Wagstaff R, Popple AW. Using clinicopathological analysis of general practitioner skin surgery to determine educational requirements and guidelines. BMJ. 1992;304(6819):93–6.PubMedPubMedCentral
43.
Maguire J, Maguire N. Three year Experience of Non-Melanoma Skin Cancer in a General Practice. Ir Med J. 2017;110(7):616.PubMed
44.
Murchie P, Delaney EK, Thompson WD, Lee AJ. Excising basal cell carcinomas: comparing the performance of general practitioners, hospital skin specialists and other hospital specialists. Clin Exp Dermatol. 2008;33(5):565–71.PubMed
45.
Gulleth Y, Goldberg N, Silverman RP, Gastman BR. What is the best surgical margin for a basal cell carcinoma: a meta-analysis of the literature. Plast.Reconstr.Surg. 2010;126(4):1222–31.PubMed
Metadata
Title
Minor surgery in general practice in Ireland- a report of workload and safety
Authors
Ailís ní Riain
Niall Maguire
Claire Collins
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Skin Cancer
Published in
BMC Primary Care / Issue 1/2020
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-020-01186-x

Other articles of this Issue 1/2020

BMC Primary Care 1/2020 Go to the issue

Research article

Organised and opportunistic prevention in primary health care: estimation of missed opportunities by population based health interview surveys in Hungary

Research article

“What counts can’t always be measured”: a qualitative exploration of general practitioners’ conceptualisation of quality for community pharmacy services

Research article

Cardiovascular risk screening of patients with serious mental illness or use of antipsychotics in family practice

Correction

Correction to: Efficiency as a determinant of loyalty among users of a Community of Clinical Practice: a comparative study between the implementation and consolidation phases

Research article

Attitudes and treatment practice of general practitioners towards patients with obesity in primary care

Research article

Specialist LINK and primary care network clinical pathways - a new approach to patient referral: a cross-sectional survey of awareness, utilization and usability among family physicians in Calgary