There are significant differences between a GP providing a commissioned skin surgery / minor surgery service (such as under a DES or LES contract) and a GPwER:

GPs providing surgical services – manage benign skin lesions and small low-risk BCC beneath the clavicle. They are first and foremost surgical services. GPs would be expected to have an understanding of lesion recognition appropriate to their surgical remit but they have not undertaken specialist training and competency based assessment in skin lesion recognition and management. In essence, skin surgery services such as DES or LES only cover clinical remits that are within the normal scope of General Practice; as such the RCGP does not consider that such roles warrant extended role accreditation. It remains good practice to make certain that the premises used are fit for purpose, and that the GP has their surgical competencies assessed (for example using a Direct Observation of Practical Procedure assessment tool) and periodically reviews their quality of their care.

GPwERs – work as an integrated team with commissioned secondary care services. GPwERs have undertaken formal specialist training and assessment in the diagnosis (clinical and dermoscopic) of skin lesions, enabling the GPwER to be commissioned to provide skin lesion clinics (excluding 2-week waits). Groups 2 and 3 GPwER can also provide surgical services with a wider remit, which may include certain BCC on the head and neck (refer to Annex C in the 2018 RCGP framework Guidance and Competencies for GPwER – Dermatology and Skin Surgery). The remit described is broad and so formal accreditation is required.