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Who's behind the mask?

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Do you know much about the role of a surgical care practitioner? Let advocate Adrian Jones fill you in …

A passionate campaigner for patient safety, the late lamented Clare Rayner was not alone in cautioning that a new culture in which nurses rather than surgeons carried out some surgical procedures might be an unwise way to proceed.

As rumours of a brave new surgical team member - the surgical care practitioner - were hitting the press in 2004, Clare Rayner wrote in the Independent newspaper: “How would you feel about the prospect of being operated on by a competent nurse, rather than an experienced surgeon? As a patient myself, I have been through an enormous amount of surgery. In my opinion a consultant surgeon should have a minimum of 15 years training and should know exactly what to do and be very experienced.”

So, were Clare Rayner’s fears justified?

In fact, operating theatre staff have always turned their hand to holding a retractor, a leg or camera, in an emergency or during staff shortages, without out this being a “legal” part of their role. The step-change however was that this new non-medical practitioner would now be expected to operate on patients. 

With the reduction of junior doctors practice hours, education changes and government waiting list initiatives all piling pressure on surgical services, in 1999 the Royal College of Surgeons, as arbiters of good surgical practice, undertook a consultation of its members as well as non-medical surgical assistants and professional associations.

Despite some controversial opposition from current surgical trainees, concerned that surgical care practitioners would usurp them in operating procedures, the outcome was positive.

The role was further endorsed with the publication of the Department of Health’s Curriculum Framework for the Surgical Care Practitioner in 2006. This set the education standards for two-year programmes, delivered in NHS clinical settings in partnership with education institutions.

A surgical care practitioner (SCP) is defined as a non-medical practitioner, working in clinical practice as a member of the extended surgical team. An SCP performs surgical intervention, -operative and pre-and-post-operative care under the direction and supervision of a consultant surgeon.

Since Suzanne Holmes, the very first surgical care practitioner, blazed a trail by joining the cardiac surgery team in Oxford’s cardiac centre in 1993, SCPs have been working in all surgical specialities, alongside surgical trainees. The SCP role is that of the second permanent member of a team in which only the consultant and SCP never vary.

New protocol-led pathways of care have been developed to enhance patient care. These days SCPs deliver pre-operative assessments, and can assist
during and undertake elements of the surgical procedure, as directed by the operating surgeon. They also ensure immediate post-op care and patient rehabilitation as part of the extended surgical team.

John Nolan, consultant surgeon and orthopaedic clinical director at my own Norfolk and Norwich Hospital, speaks for many in his role when he says that the team of five SCPs who support the hospital’s 21 consultant-led teams “provide consistent continuity of patient care whilst improving communication between all staff groups”.

As the strengths of SCPs and their role in creating surgical teams become more widely recognised, here’s hoping we can lay Clare Rayner’s and future patients’ fears to rest!

Adrian Jones is a trustee of the Association for Perioperative Practice, which has been a key advocate for surgical care practitioners. He has practised as an orthopaedic surgical care practitioner in the Norfolk and Norwich Hospital since 1996.

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