Contract Specification DES: Minor Surgery (GG&C) 2009-10 31 03 2009 DES - Minor Surgery 2009-10 Contract Mechanism and

d Specification
Introduction 1! "#ere i$ e%i&ence fro' (it#in t#e )* an& a+roa& t#at 'inor $urgica, proce&ure$ carrie& out +y genera, practitioner$ in genera, practice pre'i$e$ #a%e #ig# ,e%e,$ of patient $ati$faction an& are #ig#,y co$t-effecti%e! -1. 2. 3/ Since 1 0pri, 1990 genera, practitioner$ on 1ea,t# 0ut#ority 'inor $urgery ,i$t$ (an& t#eir e2ui%a,ent$) #a%e +een a+,e to recei%e pay'ent for un&erta3ing a range -1/ of 'inor $urgery proce&ure$ on t#eir patient$! 2! "#ere #a$ +een a #uge %ariation in t#e range of proce&ure$ un&erta3en at practice ,e%e,! Many practice$ #a%e pro%i&e& cryot#erapy. curettage an& cauteri$ation on,y (#i,$t $ti,, referring ot#er 'inor $urgery into t#e $econ&ary $ector! "#i$ Directe& En#ance& Ser%ice $c#e'e. (#ic# 'u$t +e co''i$$ione& +y e%ery 4C5. $ee3$ to en$ure t#at t#ere i$ t#e opportunity to pro%i&e t#e 'a6i'u' range of 'inor $urgery in t#e pri'ary care $ector! Scope of service to be provided 3! Cryot#erapy. curettage an& cauteri$ation (i,, continue to +e pro%i&e& +y genera, practitioner$ a$ an a&&itiona, $er%ice an& practice$ (i$#ing to opt out of pro%i&ing t#e$e treat'ent$ (i,, +e o+,ige& to app,y to &o $o in t#e pre$cri+e& 'anner! 4roce&ure$ in t#e categorie$ +e,o( an& ot#er proce&ure$. (#ic# t#e practice i$ &ee'e& co'petent to carry out. (i,, +e co%ere& +y a Directe& En#ance& Ser%ice (DES)! "#e$e proce&ure$ #a%e +een c,a$$ifie& into t#e fo,,o(ing t#ree grouping$ for pay'ent: - in7ection$ ('u$c,e$. ten&on$. 7oint$. %arico$e %ein$ an& pi,e$) - in%a$i%e proce&ure$. inc,u&ing inci$ion$ an& e6ci$ion$ E igibi ity to provide the service 8! 0 practice 'ay +e accepte& for t#e pro%i$ion of t#i$ DES if it #a$ a partner. e'p,oyee or $u+contractor. (#o #a$ t#e nece$$ary $3i,,$ an& e6perience to carry out t#e contracte& proce&ure$ in ,ine (it# t#e princip,e$ of t#e generic G4(S9 gui&ance or t#e $pecific e6a'p,e$ a$ t#ey are &e%e,ope&! C,inician$ ta3ing part in 'inor $urgery $#ou,& +e co'petent in re$u$citation an&. a$ for ot#er area$ of c,inica, practice. #a%e a re$pon$i+i,ity for en$uring t#at t#eir $3i,,$ are regu,ar,y up&ate&! Doctor$ carrying out 'inor $urgery $#ou,& &e'on$trate a continuing $u$taine& ,e%e, of acti%ity. con&uct regu,ar au&it$. +e apprai$e& on (#at t#ey &o an& ta3e part in nece$$ary $upporti%e e&ucationa, acti%itie$! :! ;#ere a 4C5 +e,ie%e$ a &octor carrying out 'inor $urgery i$ not co'p,ying (it# t#e ter'$ of t#e contract it $#ou,& in%o3e a re'e&ia, notice accor&ing to t#e proce&ure ,ai& out in <egu,ation! "#ere i$ con$i&era+,e gui&ance -8/ a%ai,a+,e on tec#ni2ue$ an& faci,itie$ for con&ucting 'inor $urgery in genera, practice! i) Sati$factory faci,itie$ 4C5$ $#ou,& +e $ati$fie& t#at practice$ carrying out 'inor $urgery #a%e $uc# faci,itie$ a$ are nece$$ary to ena+,e t#e' proper,y to pro%i&e 'inor $urgery $er%ice$! 0&e2uate an& appropriate e2uip'ent $#ou,& +e a%ai,a+,e for t#e &octor to un&erta3e t#e proce&ure$ c#o$en. an& $#ou,& a,$o inc,u&e appropriate e2uip'ent for re$u$citation! =ationa, gui&ance on pre'i$e$ $tan&ar&$ #a$ +een i$$ue&! -8/! ii) =ur$ing $upport <egi$tere& nur$e$ can pro%i&e care an& $upport to patient$ un&ergoing 'inor $urgery! =ur$e$ a$$i$ting in 'inor $urgery proce&ure$ $#ou,& +e appropriate,y traine& an& co'petent. ta3ing into con$i&eration t#eir profe$$iona, accounta+i,ity an& t#e )nite& *ing&o' Centra, Counci, ()*CC) gui&e,ine$ on t#e $cope of profe$$iona, practice! iii) Steri,i$ation an& infection contro, 0,t#oug# genera, practitioner 'inor $urgery #a$ a ,o(

Contract Specification DES: Minor Surgery (GG&C) 2009-10 31 03 2009

inci&ence of co'p,ication$. it i$ i'portant t#at practice$ pro%i&ing 'inor $urgery operate to t#e #ig#e$t po$$i+,e $tan&ar&$! 4ractice$ $#ou,& ta3e a&%antage of any of t#e fo,,o(ing arrange'ent$: 1! $teri,e pac3$ fro' t#e ,oca, CSSD 2! &i$po$a+,e $teri,e in$tru'ent$ 3! 0ppro%e& $teri,i$ation proce&ure$ t#at co'p,y (it# nationa, gui&e,ine$! Genera, practitioner$ are re$pon$i+,e for t#e effecti%e operation an& 'aintenance of $teri,i$ing e2uip'ent in t#eir practice$! 4ractice$ 'u$t #a%e infection contro, po,icie$ t#at are co'p,iant (it# nationa, gui&e,ine$ inc,u&ing inter a,ia t#e #an&,ing of u$e& in$tru'ent$. e6ci$e& $peci'en$ an& t#e &i$po$a, of c,inica, (a$te! i%) Con$ent 9n eac# ca$e t#e patient $#ou,& +e fu,,y infor'e& of t#e treat'ent option$ an& t#e treat'ent propo$e&! "#e patient $#ou,& gi%e (ritten con$ent for t#e proce&ure to +e carrie& out an& t#e co'p,ete& =1S con$ent for' $#ou,& +e fi,e& in t#e patient>$ ,ife,ong 'e&ica, recor&! %) 4at#o,ogy 0,, ti$$ue re'o%e& +y 'inor $urgery $#ou,& +e $ent routine,y for #i$to,ogica, e6a'ination un,e$$ t#ere are e6ceptiona, or accepta+,e rea$on$ for not &oing $o! %i) 0u&it ?u,, recor&$ of a,, proce&ure$ $#ou,& +e 'aintaine& in $uc# a (ay t#at aggregate& &ata an& &etai,$ of in&i%i&ua, patient$ are rea&i,y acce$$i+,e! 4ractice$ $#ou,& regu,ar,y au&it an& peer-re%ie( 'inor $urgery (or3! 4o$$i+,e topic$ for au&it inc,u&e: c,inica, outco'e$. rate$ of infection an& une6pecte& or inco'p,ete e6ci$ion of +a$a, ce,, tu'our$ or pig'ente& ,e$ion$ (#ic# fo,,o(ing #i$to,ogica, e6a'ination are foun& to +e 'a,ignant! !enchmar" pricing @! "reat'ent$ un&er t#i$ DES (i,, +e price& &epen&ing on co'p,e6ity of proce&ure. in%o,%e'ent of ot#er $taff an& u$e of $pecia,i$e& e2uip'ent! 9n 2009-10 pay'ent for an in7ection (i,, +e A82!@2 an& for cutting $urgery (inci$ion$ & e6ci$ion$) t#e fee (i,, +e AB:!28! <eference$ 1! Co(y 0. DraEier F. ?a,, M. "#o'a$ *F. ;i,,ia'$ D"! Gua,ity of 'inor $urgery +y genera, practitioner$ in 1990 an& 1991!Driti$# Fourna, of Genera, 4ractice 199:: 88H 3@8-3@: 2! "arraga CopeE 4F. Marin =ieto E. Garcia 5,'o D. Ce,a&a <o&rigueE 0. So,era 0,+ero F! -Econo'ic i'pact of t#e intro&uction of a 'inor $urgery progra' in pri'ary care/! -Spani$#/ 0tencion 4ri'aria 2001H2I(:):33:-B! 3! CopeE Santiago 0. Cara 4enaran&a <. &e Migue, Go'eE 0. 4ereE CopeE 4. <i+e$ MartineE E! -Minor $urgery in pri'ary care: con$u'er $ati$faction/! -Spani$#/ 0tencion 4ri'aria 2000H2@(2):91-:!! 8! Depart'ent of 1ea,t#! 1ea,t# +ui,&ing note 8@: Genera, 'e&ica, practice pre'i$e$! Con&on: Depart'ent of 1ea,t#! Depart'ent of 1ea,t#! Dui,&ing note 22: 0cci&ent an& e'ergency &epart'ent$! Con&on: Depart'ent of 1ea,t#!

Contract Specification DES: Minor Surgery (GG&C) 2009-10 31 03 2009

#$S %%&C Service Mechanism "#i$ DES i$ $p,it into 2 $ection$. in7ection$ an& inci$ion$ e6ci$ion$! 4ractice$ are to +e a,,o(e& to opt in to one or +ot# $ection$! "#e pay'ent 'ec#ani$' acro$$ =1S Greater G,a$go( & C,y&e for 2009-10 (i,, fo,,o( t#e 'ec#ani$' carrie& out in 200B-09! "#i$ 'ec#ani$' a,,ocate& t#e tota, +u&get a%ai,a+,e for t#i$ DES acro$$ t#e 4ractice$. +a$e& on t#eir #i$torica, acti%ity an& pay'ent$! So'e 4ractice$ carrie& out 'ore (or3 t#an t#eir +u&get a,,ocation cou,& $upport an& ot#er$ carrie& out ,e$$! "#e +u&get not $pent +y t#i$ ,atter group (a$ &i$tri+ute& on an e2uita+,e +a$i$ (after year en&) to t#o$e 4ractice$ (#o$e c,ai'$ e6cee&e& t#eir $#are of t#e tota, +u&get! 0ctua, 4ractice acti%ity i$ 3no(n for eac# 4ractice for t#e year$ 2008-0: to 200@-0I (3 year$)! "#i$ acti%ity #a$ +een a%erage& for eac# 4ractice an& (a$ t#e proce&ure co$t$ are 3no(n) a $pen& figure appen&e&. if t#e 200@-0I (a$ #ig#er. t#en t#i$ (a$ u$e& in p,ace of t#e a%erage figure! "#u$ an in&icati%e +u&get (a$ a%ai,a+,e for eac# 4ractice for 200B-09! "#i$ 4ractice figure (a$ pai& in t(e,ft#$ (a$ a +,oc3 contract $u') to eac# 4ractice! 4ractice$ (ere t#en to $u+'it t#eir actua, acti%ity figure$ to t#e GMS Contract tea' at year en&! ;#ere acti%ity (a$ ,o(er t#an t#at a,rea&y pai& for t#roug# t#e D,oc3 Contract pay'ent$. a c,a( +ac3 (a$ 'a&e! ;#ere actua, acti%ity (a$ #ig#er t#an t#at pai& for t#roug# t#e D,oc3 Contract pay'ent$. a furt#er pay'ent (a$ 'a&e. +eing an e2uita+,e $#are of t#e fun&$ re,ea$e& t#roug# t#e c,a( +ac3$ fro' ot#er 4ractice$! "#i$ reconci,iation proce$$. +a$e& on t#e pre%iou$ 3no(n acti%ity for 2008-0: to 200@-0I. (i,, a,$o +e i'p,e'ente& for 2009-10. (it# t#e year en& reconci,iation ta3ing p,ace in 0pri, 2010! "#e +u&get a,,ocate& to C,y&e 4ractice$ (i,, +e 3ept $eparate fro' t#at a,,ocate& to G,a$go( 4ractice$. (it# no cro$$-$u+$i&i$ation in 2009-10! Eac# practice i$ re$pon$i+,e for en$uring t#at t#e c,inician carrying out 'inor $urgery i$ carrying out enoug# proce&ure$ to 'aintain t#eir e6perti$e! C,inician$ (i,, on,y +e a+,e to carry out 'inor $urgery un&er t#i$ DES if t#ey (ere regi$tere& on t#e current 'inor $urgery ,i$t. or in future ((#en t#e 'inor $urgery ,i$t no ,onger e6i$t$) #a& &e'on$trate& to GG=1SD t#at t#ey #a& ac#ie%e& t#e $tan&ar& re2uire& current,y to +e regi$tere& on t#e ,i$t (G4(S9)! Decontamination of 'eusab e Devices 4ractice$ (i$#ing to pro%i&e t#i$ DES $#ou,& note t#e current gui&ance concerning t#e &econta'ination of reu$a+,e &e%ice$ an& 'u$t co'p,y (it# t#i$! GG=1SD i$ a(are of t(o co'panie$ (#ic# can $upp,y $ing,e in$tru'ent$: D! Draun Me&ica, Ct& "EC (0118) 22: 9000 <o+in$on Care Ct& "EC 01909 I3:000 4ractice$ 'ay (i$# to contact t#e$e co'panie$ an& e%a,uate t#eir pro&uct$ for $uita+i,ity!