Refer scalp lumps requiring excisional biopsy to a surgeon

Peter Mahaffey's response (BMJ 2011;341:d3521) to an earlier article
(BMJ 2011;342:d2844) illustrates one way in which the systems of the NHS
in Scotland can provide a better quality of care than those in England.

NICE rules now require all patients with skin cancers to be referred to a
dermatologist, so that onward referral to a surgeon results in treatment
delay and doubling of consultation costs. In Scotland there are no charges
for individual referrals; my dermatology colleague consults in the room
next to me on a Friday morning, and if he has a patient with a facial skin
cancer needing surgical removal he simply knocks my door and asks me to
take over management. Perhaps dermatologists in England could set up joint
clinics with a surgeon for similar patients, thus removing the referral
delay and the double clinic bill.