Waitematā GPs noted for outstanding job of skin cancer work

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Waitematā GPs noted for outstanding job of skin cancer work

Martin
Johnston
skin cancer
A skin cancer scheme in Waitematā is producing results
A skin cancer surgery scheme that relies on primary care is so successful, it should be copied throughout New Zealand, Auckland GP Chris Boberg says.

Comments

 Always  the  money  question ! 88%  of  what  dollar  value 

 On  a  case weighted basis   the price  paid  at  secondary  care level  for    operations is or was around  $2,500.  so  88% of that   leaves a fee of  $300.00. That sounds  cheap !especially  for  that  level of investment by the  practitioner . So  is the  new   CW payment   by  the  DHB  to  secondary  care  now closer to  $5000.00  which  would give a payment of  $600.00  to  primary  care .  That is  about 2.7 times  what  the   Whanganui DHB pays  primary  care  for   excising  suspicious  lesions .

 I   have a difficulty   deciding  whether  I  cut out   suspicious  lesions  or  not  when it comes to  pigmentation . My  concern is  Is it  melanoma . From my  1000 patient  base I  cut out 2-3  melanomas annually  and  also  a few  seb keratoses that  grew erraticly  and  quickly   and other  freckles . From my  point of  view   do I   review them  more often  over a period  at  a consultation  fee +  photo  fee   or do  I  cut it  out   and save all  the   buggerising around . But  who  pays if it didn't  need to  come off ?  me  because I  unnecessarily   excised a pigmented  lesion   or the DHB  ? What  is an acceptable   melanoma  to  nonmelanoma  excision  ratio ?

Taking  Photos  and  writing  referrals  to  the  DHB  takes time and  energy  , and  equipment They  still  dont take   photo attachments to  emails  and I  dont get  direct  acknowledgement of referrals  from the DHB:  thy go to the  practice manager . I  also  need  to  put the patient on  regular  and sometimes  frequent  recall  to  ensure the fast growing   Melanoma    isn't lost with cancellations  , non attendances,  Christmas, surgical holidays  etc

 The BCCS and SCCs   are a lot  easier and  my  success rate on them having  a correct pre histology  diagnosis  is  higher than  with    the  variegated , irregular  pigmented  lesions   I  stress over.  Referral  to  a dermatologist  or Mole  map  is $200-  $240 (  More than I  get paid  to  excise the  lesions  by  the WDHB   so  there is  this constant stress of too mamny   excisions   being seen as poor diagnostic skill  ,  doing it for the money ,  ripping off the  system  as opposed to  too  lenient   a criteria  for  excision .and  may be  catching  the  one  marginal  lesion that  turns out to  be a melanoma.!

 What do  other  DHBS    pay  GPs for excision of   skin cancers  do    GPs  do  punch  biopsies  first ? How many  Hutchisons  melanotic  freckles  do  you  leave  ? are those  pigment in  the  grooves   melanotic  lesions on    old skin with lots of   freckles and  vessels  left or should they all be  punch or  other biopsies  rather than referred for  surgical excision ?

 

What does Northland DHB pay GPs to excise lesions? Easy answer, nothing.

Why  nothing?

Because Northland's turned into a GP Ghetto Bill. Sadly our DHB has been singled out for special annual underfunding by the ministry, not helped by our disastrous demographic. Everything is ultimately sacrificed at the alter of surgical KPIs. 

With  the  demographic    does  Northland   get   $1000  for  each   smoker  who  gets to    4 weeks  verified    quit ? or  are you  one of the  lucky    DHBs   / PHO service  that  get  $2,000  for a 4 week  quit ?   Is there  a  Quid Pro  quo    with  the  new  PHO  service ? 

 

I have no idea Bill, all I know is as GPs we don't see a cent.