title: A regional programme to improve skin cancer management.
abstract: BACKGROUND
  In 2008, public specialist and general practice services in Canterbury were unable to manage demand for skin cancer treatment. Local clinicians decided the solution was to develop a see-and-treat skin excision clinic staffed by plastic surgeons and general practitioners (GPs), and the introduction of subsidised excisions in general practice. This paper describes the collaboration between clinicians, managers and funders and the results and quality management measures of these initiatives.
  
  
  METHODS
  There is an increasing incidence of skin cancer. GPs in Canterbury were unable to meet increasing demand for skin cancer treatment because some lacked confidence and competence in skin cancer management. There was no public funding for primary care management of skin cancer, driving patients to fully funded secondary care services. Secondary care services were at capacity, with no coordinated programme across primary and secondary care.
  
  
  RESULTS
  The programme has resulted in a greater number of skin cancers being treated by the public health system, a reduction in waiting times for treatment, and fewer minor skin lesions being referred to secondary care. Quality measures have been achieved and are improving steadily. Development of the programme has improved working relationships between primary and secondary care clinicians.
  
  
  METHODS
  The strategy was to facilitate the working relationship between primary and secondary care and increase the capacity for skin lesion excisions in both sectors.
  
  
  CONCLUSIONS
  Skin cancer management can be improved by a coordinated approach between primary and secondary care.
authors.affiliation: The Canterbury Initiative, Princess Margaret Hospital, Christchurch 8022, New Zealand. mcgeochg@gmail.com.
authors.forename: Graham R
authors.initials: GR
authors.lastname: McGeoch
authors.affiliation: General practitioner, Christchurch, New Zealand.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sycamore
authors.affiliation: The Canterbury Initiative, Princess Margaret Hospital, Christchurch 8022, New Zealand.
authors.forename: Brett I
authors.initials: BI
authors.lastname: Shand
authors.affiliation: Department of Plastic and Reconstructive Surgery, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Jeremy W
authors.initials: JW
authors.lastname: Simcock
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D003299:Cooperative Behavior; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D019468:Disease Management; D005380:Financing, Government; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration*; D058996:Quality Improvement; D012017:Referral and Consultation; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000601:surgery* / Q000628:therapy; D014850:Waiting Lists