GPs 'doing more minor operations': Incentive payments fail to reduce pressure on hospitals, survey shows

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FAMILY doctors are carrying out more minor surgery since an incentive payment was introduced, but this has had no impact on the demand for hospital treatment, according to a survey to be published tomorrow.

The survey found a 41 per cent increase in surgery by GPs since a pounds 20 fee was introduced three years ago, allowing them to earn up to pounds 300 a quarter. Researchers from Leicester suggest that some of the surgery may be unnecessary - for instance, the removal of warts which are likely to disappear by themselves.

According to the Department of Health, GPs will be paid pounds 27m this year for doing minor surgery under the scheme introduced to try to take pressure off hospital waiting lists. It was believed it would be cheaper for GPs to perform the small operations than for hospital consultants, and the scheme was also in line with policy to provide more care in the community. This week, government figures revealed that waiting lists had gone above 1 million for the first time.

Dr Adam Lowry and colleagues at Leicester University's Department of Epidemiology and Public Health analysed more than 2,000 GP operations in 22 practices, in the year following the start of the incentive scheme.

They say in the British Medical Journal that the fee is 'clearly sufficient to attract general practitioners to perform general surgery'.

They concede that a different reason for the increase might be that the need for surgery is real but that the condition would be regarded as too trivial to warrant referral to a hospital.

Dr Lowry says that the new provision in the GP contract accounts for about 2 per cent of the annual GP budget. 'The result brings into question whether a further expansion would, as has been suggested, necessarily transfer activity from the hospital to the community to any great extent. It also raises the question of whether the health benefits from minor surgical activity by general practitioners justify the priority funding.'

The types of surgery being carried out by GPs range from removing warts to removing small skin cancers. Two studies have warned against the latter practice following evidence that a significant proportion of GPs did not remove the cancers satisfactorily.

The researchers found that the largest increases in GP activity were for removing warts, an increase of 89 per cent over a year; cysts, a 60 per cent rise; ingrowing toenails, a 59 per cent rise, and abcesses, a 53 per cent rise.

A spokesman for the Department of Health said yesterday: 'While this study did not find that the introduction of payments for GP minor surgery under the new GP contract had an effect on hospital activity, it found that the GPs involved were providing a service that patients valued. Their performance was comparable to that of hospital doctors.'

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