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Nurse already carrying the endoscopy workload burden

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Nurses working in the field of endoscopy carry out a disproportionate amount of work compared with medical colleagues, a report has indicated.

Nurses make up just 8% of the endoscopy workforce but undertake as much of 20% of the workload in endoscopy units, according to researchers.

The report, published earlier this month by the Centre for Workforce Intelligence, represents the most complete picture to date of the gastrointestinal endoscopy workforce in England.

The centre was commissioned to carry out the work by the Department of Health and Health Education England to help establish whether there were sufficient endoscopists to deliver services.

It attempted to assess the size, breakdown and workload of the present workforce, and those currently in training.

The report noted that, to address demand, endoscopic procedures that had traditionally been undertaken by doctors were increasingly being performed by non-medical endoscopists, such as nurses, operating department practitioners and radiographers.

The study identified that there were 4,603 NHS and 1,239 independent sector practitioners undertaking endoscopy in England at the time of review in 2015.

The majority of endoscopists were gastroenterologists (40%), followed by surgeons (36%), doctors from other specialties (14%) and then nurses.

“Nurses make up just 8% but undertake as much of 20% of the workload in an endoscopy unit,” stated the report, noting that nurses still provided the main body of non-medical endoscopists and that there had been predictions that the profession could do even more.

“NHS Improving Quality initiatives have estimated that up to 40% of low-risk, high-volume endoscopic procedures could potentially be carried out by non-medical endoscopists,” added the report – Securing the future workforce supply: Gastrointestinal endoscopy workforce review.

It also provides a breakdown of the nurse workforce that carries out endoscopy sessions. A total of 60.9% are listed as nurse endoscopists, 26% are listed as “other”, and 8% are listed as endoscopy support.

Nurses who carry out endoscopy sessions

 Field of nurse who does endoscopyNurse headcount   Percentage of total
 Endoscopist   260  60.9%
 Other  112  26.2%
 Support staff  34  8.0%
 Gastro  7  1.6%
 IBD/IBS  6  1.4%
 Colorectal  4  0.9%
 GI cancer  2  0.5%
 Hepatology  1  0.2%
 Nutrition/dietician  1  0.2%
 Total  427  100%

Although it was able to ascertain the size of the workforce, the centre said it was unable to establish or estimate the number or relative size of endoscopist vacancies at the time of writing as none of the three datasets it analysed recorded such information.

It also noted the challenge posed by the widely different terms used in online adverts for endoscopist posts. For example, variations such as endoscopy nurse, nurse endoscopist, endoscopy practitioner, staff nurse – endoscopy all appear on the NHS Jobs and other online jobsites, it said.

In addition, the report provided a regional breakdown of the workforce and workload for different professional groups, including nurses. A distinct north-south divide emerged regarding workforce.

The highest numbers of nurse endoscopists were based in the North West, the North East and Yorkshire and the Humber. The fewest were found in the London regions and the Thames Valley.

Meanwhile, it showed that, from November 2014 to Nov 2015, 71% of all lists were gastroenterologist or surgeon-led, and 26% were nurse endoscopist-led.

The average number of lists per nurse endoscopist during the period was 36, compared to 21 across all types of clinician. The East of England, Wessex, and North, Central and East London had the most lists per nurse endoscopist.

Number of nurse endoscopists and HEE local team

HEE local team/ independent sectorNurse endoscopists                                   
 North West 95
 Yorkshire and the Humber 73
 North East 55
 West Midlands 39
 East Midlands 34
 East of England 33
Wessex 31
South West 25
Kent, Surrey and Sussex 21
South London 16
North West London 13
North, Central and East London 11
Thames Valley 10
Total (NHS) 456
Percentage (NHS) 9.9%
Independent sector 20
Total (NHS & independent) 476

Average number of lists per nurse endoscopist by HEE local team

HEE local team/ independentsectorNurse endoscopist                                   
North, Central and East London 103
East of England 59
Wessex 55
Thames Valley 48
North West London 43
South West 42
West Midlands 40
South London 34
Kent, Surrey and Sussex 29
North West 29
Yorkshire and the Humber 27
East Midlands 24
North East 24
Independent sector 26
Average 36

As well as the current workforce, the report also benchmarked the number of doctors, nurses and other clinicians taking part in a JAG Endoscopy Training System (JETS) programme.

There were 3,451 practitioners working towards gaining JETS certification as an endoscopist at the time of review. Around 82% were doctors and 15% were nurses or other non-medical trainees.

The centre’s report represents the first of a planned two-part research project. The second half is likely to be carried out by HEE.

Its brief, subject to the quality and availability of data, will be to model current and future demand for services and forecast the necessary workforce supply.

Earlier this month, the chief executive of NHS England told senior nurses that the potential of nurses working in the field of endoscopy had not been realised.

“We’ve slightly dropped the ball” over the last decade or two on “some of the expanded roles that we want for nursing”, he said at chief nursing officer’s annual summit.

Mr Stevens highlighted endoscopy as an example, noting that it was now 15 years or since the NHS first introduced nurse endoscopists. “Really, have we applied that thinking at scale – no we have not,” he said.

Non-medical endoscopists tasks with specific competencies:

  • Nurse endoscopists work independently as autonomous and competent practitioners in performing diagnostic and therapeutic procedures.
  • Nurse specialists (colorectal or gastrointestinal) and nurse practitioners (gastrointestinal or endoscopy) perform diagnostic and therapeutic gastrointestinal endoscopy as independent autonomous practitioners. They obtain informed consent from patients, administer conscious sedation/local analgesia (if they have an independent prescriber qualification otherwise the sedation has to be prescribed by a doctor), identify abnormal GI pathology, perform biopsies and therapy, photographs and complete pathology and other supplementary diagnostic tests as required. They refer to other professionals for more specialist advice as appropriate, input details of the procedure into the electronic endoscopy record, and sign off any histology post procedure (although often with the support of a consultant).
  • Endoscopy nurse tasks include assisting with initial assessment, procedures, cleaning endoscopy equipment, recovering patients after procedures, providing information to patients, continuing support and follow-up. Recent development of the role includes triaging of surveillance endoscopy procedures.
  • Healthcare assistants provide clinical and clerical support to the endoscopy practitioners such as patient chaperoning and preparation of equipment, including setting up, taking down and decontamination procedures.

Source: CFWI report


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