Any GPs out there... is this okay for a GP to do?

[Thewhimsycat]

I had a GP appt for a lump on my leg. The GP was a locum who'd returned from retirement to help out.

A varicose vein was diagnosed, which I'm happy to accept, it's only very small. But what I'm surprised about is that the locum plans to treat it themself using foam sclerotherapy.

Is this safe and normal for a GP to do themselves, in the surgery? All private offerings of this treatment seem to be done by vascular or general surgeons with use of Doppler or ultrasound. They have always been a GP, never a surgeon of any description.

Any advice would be gratefully received. If this is normal and safe then fantastic, but if it's a rogue maverick GP, I don't want to take a risk just for the benefit of free treatment.

Maybe he’s had training to do it, like some Drs perform minor surgery/remove moles etc or inject into joints for arthritis sufferers? You could have a look to see if he’s on the members directory? This says that nurses can do it with the appropriate training.

Sclerotherapy is a safe and well established injection treatment for varicose veins, spider veins and thread veins. It is practised by surgeons, doctors, nurses, dentists and beauty therapists under medical supervision.
www.bassclerotherapy.com

What makes you think it isn't OK? You sound overly anxious and suspicious to be honest.

When I Googled the procedure to find out what would be involved, almost all the hits are for private providers who seem to use vascular surgeons to perform the procedure and who use ultrasound guidance etc. I wasn't suspicious or anxious until I noticed the difference between what I was being offered and what the internet suggests the procedure should look like.

I would guess that private providers use vascular surgeons for the procedure so that they can charge more.

No sign of them on that register, but thank you. I'm sure you're right that they'll have done some additional training in their pre-retirement days.

Before allowing him to do it, I would ask what his experience in this is as it is NOT normally offered in general practice, but he may have previous vascular training and changed careers or worked as a GP with special interest.

Ask him about his experience and training. You can always say you are over anxious.
Generally thought the private sector use over qualified people to do simple procedures. Think of gynaecologists doing cervical smears that on the NHS are carried out by nurses.

Is it just a surface vein involved though? Varicose veins are often caused by the failure of one of the deeper veins and if that is not treated the problem is likely to reoccur.

I had mine done privately and had scans to ascertain exactly what was going on in my leg prior to having the laser ablation that the vascular specialist recommended.

Does he wear a bow-tie ?

NICE guidelines

www.nice.org.uk/guidance/cg168/chapter/Key-priorities-for-implementation

I thought foam sclerotherapy was done in radiology and the other option laser ablation in day units?

Imo this is not in a GP's remit (unless a dedicated minor op practice which this doesn't sound like). They seem to struggle to keep up with routine stuff without taking on minor surgical procedures. I'd ask for a referral to vascular though of course you'll have a wait. While he's playing at minor ops there'll be list of folk being told no appointments available for 3 weeks.

Maybe his GMC listing will tell you what he specialised in..? Just a thought

I was referred after some nagging by myself to have treatment and it was done in the vascular lab in my local hospital

It is pretty normal to take an interest in procedures being carried out on your body.
It is not 'overly anxious' to ask a question as to whether a treatment is normally carried out by a GP.

I think I would want to know how often and how recently the doctor had done this, given they are a locum recently returned from retirement. It does appear to have some potentially serious side effect risks associated.

Many GPs are known as GPSIs (pronounced Gypsy). It standards for GP with a special interest. This means they have enhanced training and skills in things such as Dermatology and minor surgery. The idea is to keep minor procedures local to the patient and the GP preserves NHS hospital capacity. Your GP may may have that special interest. As a registered professional, your GP cannot provide services they're not trained and assessed as competent to do as they could be struck off. You may want to ask your practice if this is the case and the reason you're not being referred

Oh wow lucky you it's really hard to get any VV treatment these days. Hope it goes well.

Maybe his GMC listing will tell you what he specialised in..? Just a thought

It's not that detailed unless he's on the specialist register. Otherwise it'll just say he's a GP.

Thanks for all the responses and for those of you making feel I'm not totally crazy to question things. He also said (when asked) that there were no risks to the procedure other than a relatively minor cosmetic one - again a quick google suggests that's not totally accurate.

For those talking about GPs wasting time on minor ops instead of doing consults, i understand why this sounds frustrating. I didn't seek out treatment in surgery.

He definitely hasn't ever worked in vascular, but has run an 'injectables clinic' at an old practice. He does have a special interest (with the relevant extra qualifications) but it's in a very unrelated area of medicine (non-surgical, non-vascular). I also know that he was a very well respected and loved GP before he retired, and seems a nice sort, who in all other circumstances I probably wouldn't be anything other than totally happy with and trusting of, so I do feel awful that I'm questioning this (hence resorting to MN rather than asking the surgery).

I'm thinking I might not take the risk and will wait and save up to see one of these overqualified surgeons.

NICE guidelines say clearly that the risks should be explained to you.

Just asked dh who is an experienced GP. He said he'd not want it for him or his family. Some GPS are ex-surgeons but you'd be able to find out.

My first reaction was 'you lucky thing', as DH was told he couldn't have his varicose veins treated on the NHS . . . and they're bad. They look really awful, I do feel sorry for him.

But then again, I agree that you'd want to do your due diligence on who is treating you if you have doubts.

(Obviously I haven't told DH his veins look awful, to be clear!)

Thanks for asking, that's really helpful. Always think 'would I want it for someone I love' is the ultimate test!

'Many GPs are known as GPSIs (pronounced Gypsy). It standards for GP with a special interest. This means they have enhanced training and skills in things such as Dermatology and minor surgery'

Yes which is fine with say diabetes or dermatology but to be competent in a surgical procedure a hcp needs to be doing it day in, day out. Not as a hobby on the side. Vascular procedures are usually done under uss control and in as sterile an area as poss like theatres not a gp consultation room. Stuff like this went on years ago at GPs, there's a reason specialists now carry out specialised procedures.

I had my vvs done at a day unti, took 15mins but it was reassuring to know all the correct kit and trained staff were available.