Minor Surgery DES. Criteria for General Practitioners

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Alexander Hudson
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1 Minor Surgery DES Criteria for General Practitioners In order to provide services under the Minor Surgery Directed Enhanced Service, a GP must be accredited or re-accredited to provide minor surgery at the appropriate level by NHS England (London Region) 1) Minor Surgery Levels of Service Minor Surgery services will encompass the following: Level 1 - Injections and aspirations Level 2 - Some invasive procedures including incisions, excisions Level 3 - Removal of low risk Basal Cell Carcinomas (BCCs) Commissioning of the above services will be dependent on an appropriate level of training and accreditation of the potential provider. All practitioners wishing to be accredited must complete the relevant sections of the application form indicating the level of service they wish to provide and relevant evidence of their suitability. Practitioners carrying out minor surgery should be competent in resuscitation with evidence of a resuscitation update within the last 18 months and, as for other areas of clinical practice, have a responsibility for ensuring that their skills are regularly updated. 2) Applying for Accreditation Practitioners wishing to provide minor surgery services should complete the relevant sections of the Minor Surgery DES Practitioners application form and submit it with the necessary documentation. 3.1) Level 1 - Injections and aspirations If you wish to provide only injections and aspirations services please complete PART A of the application form, to provide information on your post graduate qualifications and relevant experience and training. You will also be required to complete PART D (Declaration). 3.2) Levels 2 and 3 - Invasive Minor Surgery procedures All practitioners wishing to provide these Minor Surgery services should complete parts A, B and D of the application form to demonstrate that they meet the standards laid out in the relevant DH Guidance 1. This document requires that: New minor surgery practitioners must be able to evidence that they have demonstrated competency to perform the designated procedure(s) to a suitably qualified external body using objective evidence and competency based assessment tool, i.e. Direct Observation of Procedural Skills, (DOPS). Existing minor surgery practitioners wishing to be re-accredited either demonstrate competency to a suitably qualified external body using Direct Observation of Procedural Skills, known as DOPS within the preceding three years or the 1 Revised guidance and competences for the provision of services using GPs with Special Interests (GPwSIs): Dermatology and skin surgery Part 2 GPs performing skin surgery. 1

2 practitioner continues to perform skin surgery with a regular, sustained and audited level of activity (100 or more skin surgery procedures per annum 2 ). Auditing the outcomes at this level of activity will generate evidence for revalidation and reaccreditation. In addition all practitioners wishing to practice at Level 2 and 3 should be able to demonstrate training and ongoing medical education in the recognition and management of skin lesions appropriate to their level. Level 3 Practitioners, in addition, are required to meet the specific requirements under NICE (see section 3 below). All Practitioners wishing to provide minor surgery at levels 2 or 3 must complete Parts A, B and D of the application form. Practitioners wishing to provide minor surgery for Level 3 (low risk BCCs) should also complete Part C of the application form. 3) Level 3 - NICE Criteria for accreditation of GPs for low-risk Basal Cell Carcinomas (BCCs) within the framework of this DES Practitioners wishing to provide minor surgery for low risk BCCs should complete parts A, B, C and D of the application form to demonstrate compliance with the current NICE Guidance on Cancer Services 3. Appropriately accredited GPs can excise low risk BCCs from anatomical sites where excision is easy and where patients do not have any other associated risk factors and provided there is no diagnostic uncertainty as per NICE Guidance. Those GPs performing skin surgery on low-risk BCCs can only be provided within the framework of a DES. Practitioners wishing to provide this service should: Demonstrate competency in performing local anaesthesia, punch biopsy, shave excision, curettage and elliptical excision using the direct observation of procedural skills (DOPS) assessment tool in the Department Health Guidance for GPwSIs in dermatology and skin surgery 4 and then follow a program of revalidation. Attend specialist training in the recognition and diagnosis of skin lesions appropriate to their role. Provide information about the site of excision and provisional diagnosis on the histology request form. Maintain a fail-safe log of all their procedures with histological outcome to ensure that patients are informed of the final diagnosis, and whether any further treatment or follow-up is required. Provide quarterly feedback to the PCT on the histology reported as required by the national skin cancer minimum dataset, including details of all proven BCCs. Provide details to the PCT of all types of skin cancer removed in their practice as described in the 2006 NICE Guidance on skin cancer services and should not knowingly remove skin cancers other than low risk BCCs. 2 This is an indicative figure and practitioners that fall slightly below this level may be re-accredited at the discretion of NHS England (London Region), taking into account the range of procedures performed and audit outcomes 3 NICE Guidance on cancer services: Improving Outcomes for People with Skin Tumours including Melanoma (update): The Management of Low-risk Basal Cell Carcinomas in the Community (May 2010) 4 Department of Health (2007) Guidance and competencies for the provision of services using GPs with special interests (GPwSIs): dermatology and skin surgery. Available from 2

3 Provide evidence of an annual review of clinical compared with histological accuracy in diagnosis for the low risk BCCs they have managed attend, at least annually, an educational meeting (organised by the Skin Cancer Network Site Specific Group), which should: present the 6-monthly BCC network audit results, including a breakdown of individual practitioner performance - include one CPD session (a total of 4 hours) on skin lesion recognition and the diagnosis and management of low-risk BCCs - be run at least twice a year. 4) Maintaining your Accreditation Practitioners will be required to produce evidence for re-accreditation every 3 years in order to maintain their accreditation.. 5) Information on courses The Royal College of General Practitioners offers accredited Minor Surgery Courses and Joint Injection Courses. Visit for further information. Courses are also available through the Primary Care Dermatology Society and the Association of Surgeons in Primary Care amongst others. Assessment of knowledge and skills is provided by these and a number of organisations and practitioners are recommended to obtain from their chosen course provider an assurance that the necessary standards are met. 3

4 Minor Surgery DES 2014/15 Application for Practitioner Accreditation PART A (Levels 1 3) This Section to be completed by ALL GPs wishing to provide Minor Surgery Directed Enhanced (DES) Services. Details of GP Surname Forename Address Date of full registration GMC Number Practice name(s) at which Minor Surgery DES services are to be carried out POST GRADUATE QUALIFICATIONS Please list all post graduate qualifications relevant to your application. Qualification Date achieved 4

5 Providing minor surgery services in General Practice. Please indicate which level/s of minor surgery service/s you wish to provide: Level 1 - Injections and aspirations Please delete as appropriate Level 2 - Invasive procedures, e.g. incisions, excisions Level 3 - Invasive procedures including the removal of low risk Basal Cell Carcinomas (BCCs). Date of last attendance at CPR Training (Please ensure you are able to produce a copy of your certificate of attendance, if requested by NHS England) Date: Relevant Experience Please give information about all minor surgery experience in the last three years relevant to the level at which you are applying (please supply references). 1) Name of Organisation : (this may include your own or another general practice) Position held: Dates: Type of Minor Surgery activities undertaken, e.g. joint injections, excision of benign lesions, excision of BCCs: Activity Levels (annual) Please be specific about the no. of procedures of each type performed: Referee Details: 2) Name of Organisation: Position held: Dates: Type of Minor Surgery activities undertaken, e.g. joint injections, excision of benign lesions, excision of BCCs: Activity Levels (annual) Please be specific about the no. of procedures of each type performed: 5

6 Referee Details: 3) Name of Organisation: Position held: Dates: Type of Minor Surgery activities undertaken, e.g. joint injections, excision of benign lesions, excision of BCCs: Activity Levels (annual) Please be specific about the no. of procedures of each type performed: Referee Details: Relevant Training Please give information about all minor surgery training attended in the last three years relevant to the level at which you are applying (Please ensure you are able to produce a copy of your certificate/s of attendance, if requested by NHS England) Course 1 Name of training course and details of course content: Date Attended: Course 2 Name of training course and details of course content: Date Attended: Course 3 Name of training course and details of course content: Date Attended: Course 4 Name of training course and details of course content: Date Attended: 6

7 PART B This Section to be completed by GPs wishing to provide Level 2 or 3 Minor Surgery Directed Enhanced (DES) Services. Direct Observation of Procedural Skills, (DOPS) New (and some existing) minor surgery practitioners must be able to evidence competency to perform the designated procedure(s) to a suitably qualified external body using objective evidence and competency based assessment tools, i.e. Direct Observation of Procedural Skills, (DOPS), within the preceding three years. Did any of your training courses that you have entered above include a DOPS assessment? If YES Name of course/s: If NO Have you evidence of having completed a DOPS assessment in the past 3 years? Name of DOPS Provider : (please delete as appropriate) (please delete as appropriate) If YES please provide details below Date completed: If NO Please confirm that you have booked to attend a DOPS assessment, including name of course, venue and date: PART C - Level 3 Minor Surgery This Section to be completed by GPs wishing to provide Level 3 Minor Surgery Directed Enhanced (DES) Services for low risk BCCs. Relevant Training GPs performing skin surgery on low-risk BCCs are required to demonstrate competency in performing local anaesthesia, punch biopsy, shave excision, curettage and elliptical excision using the direct observation of procedural skills (DOPS) assessment tool in the Department Health Guidance for GPwSIs in dermatology and skin surgery. Please indicate which course detailed in PART A meets this requirement. Name of training course and details of course content Reporting Requirements GPs performing skin surgery on low-risk BCCs are required to meet full reporting requirements as specified in Section 3 of this document and the NHS England (London Region) Minor Surgery DES specification. Please place a tick in the adjacent box to confirm that you will meet these requirements: 7

8 PART D To be completed by ALL applicants DECLARATION I declare that the information provided on this form is correct. Doctors Signature: Name Printed: Date: 8

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