title: Safety of community-based minor surgery performed by GPs: an audit in different settings.
abstract: BACKGROUND
  Minor surgery is a well-established part of family practice, but its safety and cost-effectiveness have been called into question.
  
  
  OBJECTIVE
  To audit the performance of GP minor surgeons in three different settings.
  
  
  METHODS
  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).
  
  
  METHODS
  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 χ(2) 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Royal College of General Practitioners, London.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Botting
authors.affiliation: University of Surrey, Guildford.
authors.forename: Ana
authors.initials: A
authors.lastname: Correa
authors.affiliation: Health and Social Care Information Centre, Leeds.
authors.forename: James
authors.initials: J
authors.lastname: Duffy
authors.affiliation: University of Surrey, Guildford.
authors.forename: Simon
authors.initials: S
authors.lastname: Jones
authors.affiliation: University of Surrey, Guildford, and director of the RCGP Research and Surveillance Centre, Royal College of General Practitioners, London.
authors.forename: Simon
authors.initials: S
authors.lastname: de Lusignan
mesh_terms: D000553:Ambulatory Care; D057189:Checklist; D002983:Clinical Competence / Q000592:standards*; D017558:Elective Surgical Procedures; D058005:General Practitioners / Q000592:standards; D006801:Humans; D013511:Minor Surgical Procedures / Q000592:standards* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration; D011361:Professional Competence; D011787:Quality of Health Care / Q000592:standards*; D006113:United Kingdom
keywords: clinical audit; dermatology; general practice; minor surgical procedures; quality improvement; skin neoplasm