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HEE at odds with DH over advanced critical care and surgical care practitioners

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Advanced critical care practitioners (ACCPs) and other similar roles increasingly used to assist doctors should be regulated to “mitigate the risk of harm to patients”, according to England’s national workforce planning body, in contrast to the government’s current view on some such posts.

Health Education England said it wanted to see ACCPs, surgical care practitioners, physician associates, and physician assistants working in anaesthesia regulated, as revealed in recent board papers.

“ACCPs represent the only genuine and sustainable solution to the shortage of critical care junior and middle grade doctors”

Health Education England


It has called for these steps to be taken in response to a consultation the government is running on whether to introduce statutory regulation for all four of these roles – known collectively as medical associate professions.

Nurses and other allied health professionals can move into the posts once they have gained further qualifications, but there are currently no measures in place for regulation or standardised training.

But, in its consultation document, the government said the four UK health departments were “not persuaded by the case for introducing statutory regulation for the surgical care practitioners and ACCP roles at this time”.

This is because these roles are only suitable for healthcare professionals who are already registered – and therefore regulated – said the documents.

“The government is not persuaded by the case for introducing statutory regulation for advanced critical care practitioners”

Consultation document

In addition, it said the departments did not believe there was “sufficient” evidence ”at present” to decide whether physician assistants working in anaesthesia should be regulated.

It said more information was needed on the role’s level of clinical autonomy and scope of practice.

However, the government said the health departments believed that regulation of physician associates was “necessary and proportionate”.

Meanwhile, according to HEE’s estimations, there are 100 qualified ACCPs in the UK and further 100 in training, the majority of whom are nurses.

In a risk assessment published by HEE as part of the consultation, the arms-length body said “ACCPs represent the only genuine and sustainable solution” to the shortage of junior and middle grade doctors in critical care.

surgery surgeons

surgery surgeons

It predicted there could be more than 2,000 posts created in the UK if every level 2 and level 3 critical care unit each employed around 10.

Those working as an ACCP must have gained a relevant postgraduate diploma or master’s degree and must be qualified to prescribe to the same level as a doctor, noted HEE in its assessment.

There have been increasing calls for advanced nurse practitioners (ANPs) more generally to be regulated in the past year due to growing concerns about the lack of standardisation of training and of responsibilities for those in the role.

At the end of 2017, the first national framework for nurses and other healthcare professionals working at an advanced level was jointly published by NHS organisations.

In light of its recommendation that ACCPs and other medical associate professionals should be regulated, Nursing Times asked HEE whether it believed all nurses working at an advanced level should be regulated but it declined to comment further.

Meanwhile, the workforce body estimates there are currently around 200 surgical care practitioners in the UK, a role that is open to registered professionals with at least 18 months’ experience in a clinical perioperative background.

“Currently the numbers of SCPs are relatively small but there may be an increased need to support the workforce of the future,” said HEE.

“The growing predicted deficit… supports a likely future expansion in the non-medically trained anaesthetic workforce”

Health Education England

There are also around 400 physician associates in the UK – expected to rise to 3,500 by 2020, including 1,000 in GP practices due to government targets.

They complete a two-year postgraduate diploma or degree, and usually have a biomedical science degree – though some courses accept registered healthcare professionals such as nurses.

The total number of physicians’ assistants working in anaesthesia is thought to be 145. Those in the role complete a 27-month post graduate diploma and are usually graduates with biomedical or biological science degree, or registered healthcare professionals with at least three years’ clinical experience.

“Whilst there are no active targets for the expansion of this role by the Department of Health, the growing predicted deficit of more than 3,000 medical anaesthetists identified by the 2015 Centre for Workforce Intelligence report supports a likely future expansion in the non-medically trained anaesthetic workforce,” said HEE.

ICU nurse: critical care is one specialty

ICU nurse: critical care is one specialty

HEE told Nursing Times that it wanted to see all four roles regulated as a single professional group, but stressed it was down to the Department of Health to decide.

The government’s consultation document reveals it is most in favour of either the General Medical Council or the Health and Care Professions Council becoming the responsible body if statutory regulation goes ahead for any of the roles.

The consultation ran from 2 October to 22 December 2017 and the responses are currently being analysed.

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