Now your GP can remove life's little troubles

Jeremy Laurance on the growth of fast operation shops, where family doctors are ready and waiting with a knife
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It's The surgical equivalent of the fast-food joint. You queue up, they slice you open, stitch you up and send you home. Skin cancers, varicose veins, assorted lumps and bumps: all are going under the knife in the local GPs' surgery.

The service is quick, convenient and efficient. And because the GPs do a lot of operations, standards are consistently high.

The trend is growing as a result of advances in techniques which have brought smaller incisions, better anaesthetics and faster recovery times. But it is set to accelerate after the Government announced plans to shift hospital services into the community in its White Paper, The New NHS, published this month.

One model for the future is at the Greenwood Medical Centre in Nottingham, where two family doctors who specialise in minor surgery are now taking referrals from 100 GPs in the surrounding area. Between them they operate on 1,500 patients a year, excising cancerous growths on the skin, injecting varicose veins, removing ganglia (swellings in joints) and performing vasectomies as well as the routine burning off warts and treating ingrowing toenails.

"It is a lumps-and-bumps service and all our surveys show high levels of satisfaction because it is easy for patients and they don't have to wait," said one of the pair, Dr Simon Fradd. "Our contract says we must treat patients within four weeks but in practice we see everyone in two weeks. If the waiting list starts to grow we put on an extra session."

Patients are booked in for an hour and get a cup of tea afterwards if they need it. All operations are done under local anaesthetic which means recovery is swift and patients can go home almost immediately.

Dr Fradd said: "The service we offer is more specialised than that provided by hospital consultants. Two of us here have done betweeen 6,000 and 7,000 operations and we have developed special skills."

The practice has developed a new technique for dealing with cysts caused by blocked sweat glands. The conventional way involves making a large incision through which the cyst is extracted. This requires three stitches and leaves a scar. "Now we have a technique which requires one stitch, which means less scarring. It is like keyhole surgery on a small scale," Dr Fradd said.

In other areas they have learnt by experience. With warts they have found the only way to remove them permanently is to burn them off, to kill the virus. This treatment is offered only if the patient has already been using a wart removal cream for at least six months.

Much of their work is concentrated on the face, which other GPs tend to avoid because of the risk of scarring. Many GPs might attempt the removal of a small lipoma - a fat lump under the skin - but if it is large or located on the face they are likely to refer elsewhere.

The service is cheap and quick, as well as being an improvement on the hospital version. Instead of being referred to an outpatients' clinic for examination, returning for the operation and then attending a third time for a check-up, patients can be dealt with in single visit.

Dr Fradd and his colleague, Dr Ross Martin, charge a flat-rate pounds 60 for each operation, paid by the health authority, with a reduced rate of pounds 30 for procedures such as wart removals and joint injections. This compares with around pounds 250 in hospital. The contract is worth pounds 60,000 a year which allows them to buy equipment and employ a secretary.

There is some resistance to the service from hospital doctors. A plan by the practice to offer patients with blocked noses treatment to wash out their sinuses and remove nasal polyps was vetoed.

"Local consultants found all sorts of reasons why we shouldn't do it," Dr Fradd said.

However, the pressure to do more is growing. Under the Primary Care Act, which became law shortly before the election, health authorities were given the power to transfer money from hospitals to GPs and community health services. This month's NHS White Paper, which proposes giving control of most of the NHS budget to Primary Care Groups, comprising local GPs and community nurses, will accelerate that process.

In the Government's vision, GPs of the future will control the NHS's purse strings, which will offer them an incentive to provide as much care locally as possible - where it is the cheapest and most convenient for patients.

Increasingly, hospital services will be shifted into the community and, with the development of Primary Care Trusts, run by Primary Care Groups and including community hospitals, GPs are expected to end up employing hospital doctors and offering a wide range of surgical and other services.