Skinspots founder and Western Bay of Plenty Primary Health Organisation GP with special interest in skin surgery Dr Franz Strydom. Photo / Supplied
A Tauranga skin cancer doctor fears some patients will be waiting “months” for surgery after a funding change made them no longer eligible for funded community-based care.
Western Bay of Plenty skin cancer patients who are not Community Services Card holders or do not have a suspected melanoma lesion will be referred to the hospital for treatment.
Previously, all patients, regardless of community card status, could access community-based treatment for lesions that met the eligibility criteria.
The change to the Skin Lesion Service, operating since 2009, came into effect on July 1.
Western Bay of Plenty Primary Health Organisation (PHO) network services general manager Wendy Dillon said it was in response to growing demand driven by population growth and high rates of skin cancer, while the service continued to operate within the same fixed budget.
“We have explored all current options to secure additional funding, but none have been successful.”
Funding would now focus on those “more likely” to face barriers to care, to ensure the service’s sustainability, she said.
“Introducing clear, equity-based criteria was the most practical way to match access with available resources.”
In the Bay, skin lesion removal could be accessed through general practices, specialist clinics, dermatology services, private providers, and Te Whatu Ora hospital teams.
General practitioner with special interest in skin surgery, Dr Franz Strydom, said in his view, it was “very unfortunate” that skin cancer treatment was “so underfunded”.
The Skinspots founder, who helped establish the Skin Lesion Service, said less than 10% of skin cancers were removed by GPs when it first started. Now, it was 80%.
“That 80% ... are now being loaded back on to the hospital.”
Strydom said a GP charged between $300 and $600 for a “simple elliptical excision”.
Private specialists would charge closer to $2000.
“We have so many people who can’t afford it and have to go on a waiting list.”
Strydom said the hospital waitlist was “months”.
Patients no longer eligible for community-based care would “wait so much longer, and the cancers don’t stop growing”.
He said there was no national, equitable funding approach and the problem would “get worse” without one.
“It is the decision makers who control the funding ... this decision has caused a major disaster - almost - for people with skin cancer.”
Health NZ Te Whatu Ora Bay of Plenty operations group director Pauline McGrath said the Tauranga community had been well supported by the skin lesion programme.
As a result, the waitlist for skin lesion surgery at Tauranga Hospital was 81 patients. This included basal cell carcinoma, squamous-cell carcinoma and melanoma, McGrath said.
The current average wait time for surgery was 102 days, she said.
McGrath said those with the most urgent clinical needs were prioritised for treatment.
“We are committed to reducing wait times and continue to put in place systems and processes, so improvements are made.”
Dillon said the service was initially established to reduce pressure on hospital teams “by shifting appropriate procedures into the community” and carried out by credentialed GPs.
She said not all skin lesions were eligible for funded excision. Referrals were reviewed weekly by an independent triage clinician using a priority scoring system.
Based on this assessment, eligible cases were directed to credentialed GPs while those that exceeded “clinical or contractual thresholds” were referred to hospital.
Patients no longer eligible for community care had the option of being referred to hospital services for funded care, Dillon said.
Those who preferred not to wait or would rather receive treatment in a community setting may choose to pay for their procedure, she said.
“We know this may mean longer wait times for some patients. However, the change allows us to maintain access to care for all, just through different pathways.”
Dillon said, regardless of where treatment took place, “all life-threatening or life-limiting skin cancers” were treated within the required time frames under the Faster Access to Cancer treatment directive.
This directive was Health NZ’s target for 90% of patients to receive cancer management within 31 days of the decision to treat.
The PHO would keep exploring options to secure additional funding.
Health NZ Te Manawa Taki regional planning, funding and outcomes director Nicola Ehau said there was “significant variation” in how skin lesion services were funded and accessed nationally.
A “minor dermatology workstream” focused on skin lesions was being established in the coming months to address this. It would sit within a national programme called extended primary and community care.
The programme aimed to develop a “nationally consistent framework” for clinical guidelines, pricing, data collection, and performance measurement across acute and planned care services, “helping to ensure equitable access and improved service delivery”.
Ehau said there had been no reduction in funding for skin lesion removal in the Bay.
“However, we accept the need to prioritise access while the nationally consistent criteria are developed.”
Pigmented lesions where histology or provisional diagnosis indicates:
Non-pigmented lesions, if the lesion meets the triage score and histology or provisional diagnosis indicates:
Lesions excluded from the programme include common skin conditions such as seborrheic keratoses, lipomas, sebaceous cysts, warts, solar keratoses, and other non-malignant lesions not listed above.
Megan Wilson is a health and general news reporter for the Bay of Plenty Times and Rotorua Daily Post. She has been a journalist since 2021.