Journal of Public Health 26(3) © Faculty of Public Health 2004; all rights reserved.
Impact of the introduction of fee for service payments on types of minor surgical procedures undertaken by general practitioners: observational study
Pete Pockney, Research Fellow, University Surgery, University of Southampton, F Level, Centre Block, Southampton General Hospital, Southampton SO16 6YD, UK
John Primrose, Professor of Surgery, University Surgery, University of Southampton, F Level, Centre Block, Southampton General Hospital, Southampton SO16 6YD, UK
Helen Kinley, Researcher, University Surgery, University of Southampton, F Level, Centre Block, Southampton General Hospital, Southampton SO16 6YD, UK
Steve George, Reader in Public Health, University of Southampton Health Care Research Unit, B Level, South Academic Block, Southampton General Hospital, Southampton SO16 6YD, UK
Val Lattimer, MRC Fellow, University of Southampton Health Care Research Unit, B Level, South Academic Block, Southampton General Hospital, Southampton SO16 6YD, UK
Helen Smith, Reader in Primary Care, Primary Medical Care, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, UK
Paul Little, Professor of Primary Care, Primary Medical Care, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, UK
Adam Lowy, Epidemiologist, Swiss Institute for Applied Cancer Research, SIAK Koordinationszentrum, Effingerstrasse 40, 3008 Bern, Switzerland
Roger Kneebone, General Practitioner, Lovemead Group Practice, Roundstone Surgery, Polebarn Circus, Trowbridge BA14 7EH, UK
Address correspondence to Dr S. George. E-mail: pluto{at}soton.ac.uk
The 1990 general practitioners (GPs) contract introduced item of service payment for minor surgery, payable for six categories of procedure. Early review showed no substitution of cheaper procedures for more expensive treatments. Detailed payment data from six Health Authorities for the period 1993–2000 show an 11 per cent increase in claims, largely accounted for by the rise in cautery, incorporating cryotherapy. Cryotherapy is no more effective at treating warts than cheap commercially available products, but is quite profitable for GPs. This is yet another example of item of service payment distorting treatment priorities. The new GP contract, and the initiative to develop GPs with special interests in dermatology and minor surgery, will allow primary care trusts to develop minor surgery undertaken by appropriately skilled and experienced GPs, and which reflects the needs of the population.