Improving outcomes for people with skin tumours including melanoma

Network-wide protocols
It is not possible to determine the cost implications of network-wide
protocols, as these are dependent on clinical guidelines and may
result in an increase or decrease in costs.
Improving Outcomes for
People with Skin Tumours
including Melanoma
Organisation of skin
cancer services
Clinicians working in the community
There may be resource implications for those networks that decide to
provide GPwSI services in the community. The need for community
skin cancer clinics will vary according to the expertise available and
ease of access to local hospital departments. Some networks already
have such services in place and it will be for local commissioners to
decide whether to establish them. The costs have been expressed as:
• sessional rates paid to GPwSIs, inclusive of a locum
• hospital practitioner rates, and
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• a more comprehensive service cost that includes GPwSI, nurse
and administrator’s time and consumables.
For a network to deliver 30 sessions a week for 52 weeks of the year,
the annual cost of GPwSI sessional payments would be around
£329,373 (±25% range, £247,030 to £411,716). Thirty sessions in a
network equates to 3.4 sessions per PCT/LHB. At hospital practitioner
rates the payment would be £196,773 (±25% range £147,580 to
£245,966). The costs on a network level for the service inclusive of
GPwSI, nursing time, administration and consumables is around
£625,727 per network (±25% range, £469,296 to £782,159). These cost
scenarios have a high degree of uncertainty as they include costs for
patients that have conditions other than NMCS. It needs emphasising
that the costs have been presented for information purposes, and it is
for local commissioners to investigate whether a GPwSI service would
enhance their existing services.
At present, GPwSIs can gain training by working alongside a
consultant dermatologist and/or by taking a specific postgraduate
qualification. The British Association of Dermatologists recommends
that 100 consultant-supervised training sessions per GPwSI are
necessary to fulfil all the necessary training requirements. This is in
addition to service provision time. The estimated cost for 100 training
sessions with a consultant would be £18,900 for the consultant time
and £21,000 for the GPwSI, inclusive of GP locum costs. The costs of
a distance-learning postgraduate qualification in dermatology would
be in the region of £3000 per GP. Therefore the non-recurring cost of
training each GPwSI would be around £42,900. There would also be
Guidance on cancer services: skin tumours including melanoma
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