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

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 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.

Office-Based Minor Surgery: An Ever-Increasing Challenge Not Only for the Dutch General Practitioner

“…Is it safe, and will it reduce national health costs ? 1,[5][6][7][9][10][11]14,18,20,21,23,27,29 Nelligan et al demonstrated that OBMS driven entirely by family physicians significantly lowered health spending at their AMC. Perhaps more equitable payment for OBMS (greater than 20% of hospital rates) could still contribute to lower national health care costs, and also better support the GP practices to provide the proper equipment and staffing to provide OBMS in safe and timely manner.…”

“…Office-based minor surgery (OBMS) has traditionally been a feature of general practice. [1][2][3][4][5][6][7][8][9][10][11] OBMS refers to all surgical procedures performed under local anesthetic, typically in the office setting. This includes a wide variety of procedures, ranging from minor excisions of dermatological imperfections and tumors, incision of abscesses, suturing wounds, and removing foreign objects, to more therapeutic procedures such as elective partial matrixectomy and thrombosed hemorrhoid treatment.…”

“…16 Despite the advantages of performing OBMS in primary care, research in different countries showed great variation in the numbers of GPs performing OBMS and in GP referral rates. 4,[7][8][9]11 This variation may be partly due to safety concerns associated with OBMS in general practice. 5,10,11,14,[17][18][19][20][21][22] Previous studies have reported that safety depends on the skills and training of the GP.5,21,22 Some therefore suggest that, to enhance safety, specific skills are required in order to perform OBMS.…”

“…4,[7][8][9]11 This variation may be partly due to safety concerns associated with OBMS in general practice. 5,10,11,14,[17][18][19][20][21][22] Previous studies have reported that safety depends on the skills and training of the GP.5,21,22 Some therefore suggest that, to enhance safety, specific skills are required in order to perform OBMS. 5,20,21,23 Dutch GPs are expected to have the basic skills required to perform minor surgery after completing their GP training.…”

Minor surgery in primary care has reduced minor surgery waiting lists: a 12-month review

“…There has been a trend in general practice towards evolving services provided and utilising the skills in primary care. This would in turn augment and support the care provided by secondary care [4]. Currently, many minor procedures, such as punch biopsies and basic non-melanoma skin surgeries, are carried out in a fully staffed surgical theatre, increasing the burden on secondary care physicians.…”