Saving Your Skin: Greater Cover for GPs

An analysis of data collected from Medicare Australia on the frequency of billings under selected item numbers showed that between 2001 and 2005 the number of skin cancer excisions and surgical repairs performed by GPs and specialists in Australia increased.

The findings also revealed an increased rate of surgical repairs done by both GPs and specialists, with GPs increasing their use of flap repairs by 75% over the four-year period.² With skin cancer (melanoma and non-melanoma cancers) accounting for the largest number of cancers diagnosed in Australia each year,³ the rates of GP excisions and flap repairs are expected to continue rising over time. As GPs become more active in skin cancer treatment, their risk profile also changes – as illustrated in the case below.

Case study

A decision by the Civil and Administrative Tribunal (NSW) in 2016 resulted in disciplinary action being taken against a GP over his treatment of nine patients for skin cancers. The GP, who was qualified in skin cancer medicine, had his registration cancelled after being found guilty of professional misconduct and determined unfit to practise medicine on account of an impairment.⁴ 

Discussion

One of the nine patient cases considered by the Tribunal involved the treatment of Bowen’s disease on the right side of the patient’s nose. In that case, the practitioner conceded he had failed to discuss options for treatment of the disease, and inappropriately recommended and planned to continue with a full thickness skin graft for repair of the wound on the patient’s right ala, rather than referring her to a specialist. 

An expert commissioned by the Health Care Complaints Commission was critical of the GP’s choice of full flap skin graft, stating it would have resulted in a significantly poorer outcome. The expert was also critical of the GP’s failure to refer the patient to an ENT specialist upon realising the patient’s nasal architecture may be compromised. Further, the GP’s wound care instructions fell below the standard reasonably expected of a practitioner of the same training and expertise.

This case illustrates the importance of practising within the limits of one’s skillset, and appreciating when referral to another specialist is clinically warranted.

Important information for General Practitioners treating skin cancers

MDA National’s risk categorisation of skin grafts and flaps has been reviewed and amended from Level 2 GP Limited Procedures and Level 3 GP Procedural as follows:

• Single stage local flaps for the removal of skin lesions and defect repairs are covered under the Level 1 General Practice Non Procedural category with no anatomical restrictions on the areas of the body upon which such flaps can be performed.


• Free grafting (split skin) and full thickness grafts are also covered within the risk category Level 1 General Practice Non Procedural category with no anatomical restrictions.


• GP Members undertaking skin cancer treatments on the face will be covered under the Level 1 category for administering facial nerve blocks including supraorbital, infraorbital, submental and peripheral Trigeminal nerve blocks.

It is important to be aware that it is a requirement under your Professional Indemnity Insurance Policy that you are acting within your field of practice and have the appropriate training and qualifications for any procedures undertaken.  

The details of the changes are outlined on Page 14 in the 2018/19 Risk Category Guide for Medical Students and Medical Practitioners. If you believe the above amendments may impact the risk category in which you are currently indemnified, please contact our Member Services team for further discussion by phone: 1800 011 255 or email: peaceofmind@mdanational.com.au.

See articles from our previous GP Updates.

1. Askew DA, Wilkinson D, Schluter PJ, Eckert K. Skin Cancer Surgery in Australia 2001-2005: The Changing Role of the General Practitioner, MJA 187 (4) 20 August 2007: 210-214. Available at: mja.com.au/journal/2007/187/4/skin-cancer-surgery-australia-2001-2005-changing-role-general-practitioner
   
2. Ibid. 213.
   
3. Australian Institute of Health and Welfare 2016. Skin Cancer in Australia. Cat. No. CAN 96. Canberra: AIHW.
   
4. Health Care Complaints Commission v Reader [2016] NSWCATOD 152.