The National Association of Assistants in Surgical Practice

 

Executive Committee What is a Surgical Care Practitioner? NAASP Surgical Care Practitioner Position Statement What is an ASP? The ASP Position Statement

About NAASP

NAASP Surgical Care Practitioner Position Statement

 

Introduction

There have been a number of changes within healthcare delivery since the 1980s. Perhaps the most influential regarding role developments of non-medically qualified practitioners have been the Scope of Professional Practice (UKCC 1992), the NHS Plan (DH 200), the European Working Time Directives (DH 1998) and Modernising Medical careers (DH 2004). These policy documents coupled with demographic changes in society and an increase in patient expectations have resulted in many areas of role expansion for non-medically qualified practitioners.

 

Within the perioperative environment this has led to the development of two distinct roles, the Surgical Care Practitioner (SCP) and the Advanced Scrub Practitioner (ASP). NAASP has already provided a position statement for the ASP role (see www.naasp.org.uk) along with other professional organisations. As part of NAASP’s ongoing commitment of continually striving for excellence in practice and providing its members with information and advice, NAASP feels it appropriate to provide a position statement for the role of the SCP.

 

The SCP role

The SCP role is not a development of the 21st century but has been evolving since the 1980’s with Suzanne Holmes acknowledged as possibly the first SCP in cardiac surgery. Her role at the time was to harvest the saphenous vein for coronary artery bypass grafts, having undergone specific training in the USA. In the 1990’s this role became more contentious with reports both in the nursing and medical press and also in the popular press with evocative titles of ‘nurses wielding scalpels’ and ‘mini doctors not maxi nurses’. The idea being that nurses wanted to be doctors and were rising above their station. However, what became clear was that SCPs did improve patient care albeit anecdotal. They provided continuity of care in the surgical environment and enhanced the patients’ surgical experience. As with the ASP title the SCP has also been called different things, Surgeon’s Assistant, Nurse as Surgeons Assistant and Surgical Assistant. It was felt that these titles caused confusion, not only within health care but also more importantly amongst patients, misleading patients into believing that SCPs were medically qualified. The Department of Health established a working party looking at the education and training of SCPs and in discussion with the public decided that the title that caused the least confusion should be Surgical Care Practitioner; this is the current accepted working title for this role.

SCP Definition

NAASP first produced the definition of the SCP in 2002 which was amended in 2005 to;

‘A Surgical Care Practitioner is a practitioner working both in and out of the operating room who undertakes specified surgical intervention either under direct, indirect or proximal supervision’ (NAASP 2005).

With the publication of the Curriculum Framework document for the Surgical Care Practitioner (DH 2006) the definition was further refined, the current definition being

‘A non-medical practitioner, working in clinical practice as a member of the extended surgical team, who performs surgical intervention, pre-operative and post-operative care under the direction and supervision of a consultant surgeon’ (DH 2006).

Both of these definitions acknowledge that it is not just nurses who undertake this role but other health care professionals such as Operating Department Practitioners, Physiotherapists and other professions allied to medicine. The definitions also acknowledge that the role does not just take place within the operating room environment but that it is much wider encompassing all aspects of pre, intra and post operative care of the surgical patient. The SCP becomes part of the surgical team and is involved in a variety of aspects of patient care and treatment, some of which may involve surgical intervention.

Scope of the role

The scope of the role of the SCP has been established by the curriculum framework document (DH 2006) (see table 1). Although there are elements of the role which overlap with the ASP role, the scope of the SCP is considerably larger. Whereas the ASP remains part of the theatre establishment, the SCP joins the wider surgical team and becomes responsible to the consultant surgeon(s) in charge of their team(s). The SCP is no longer responsible to the theatre establishment.

 

Under the direction of a consultant surgeon, SCPs may participate in:

  • Pre-operative assessment and physical examination as directed by the surgical team
  • Assisting with the preparation of patients for surgery including venepuncture, male and female catheterisation, patient positioning and preparation
  • Assisting with surgical procedures in the operating theatre as part of the multidisciplinary team for the surgical specialty under the supervision and direction of the operating surgeon
  • Being first or second assistant at operations as directed by the supervising consultant surgeon
  • Some technical and operative procedures according to their scope of practice
  • Facilitating the continuity of care of patients
  • Facilitating the training of trainee surgeons by supporting a training session or providing delegated care to a patient while the consultant surgeon is conducting a training session
  • Arranging appropriate pre and post-operative investigations as part of the multidisciplinary team
  • Liaising with medical, theatre, ward and clerical staff on relevant issues such as theatre lists to support coherent service provision
  • Post-operative care, including wound assessment, initial treatment and identification of surgical problems and complications
  • A variety of outpatient activities, including seeing patients  as and when they are deemed competent to do so
  • The evaluation of care, including the discharge process and follow-up care arrangements for surgical patients

Table 1 (DH 2006)

 

Although the SCP is clinically responsible to the consultant surgeon(s) within the team(s) that they work for, professionally the SCP remains accountable to their professional registering and regulating body. In the case of nurses adopting the SCP role then this would be the NMC, if the SCP is an Operating Department Practitioner then they remain accountable to the HPC. As with the ASP, the SCP must recognise their own role limitations and not practice or undertake any clinical interventions unless they are competent to do so. Competence in practice must be clearly established and documented (NMC 2008, HPC 2008, DH 2006). The SCP remains accountable for their acts and omissions and no-one else can accept accountability on behalf of anyone else.

The scope of practice of the SCP is based on the NAASP voluntary code of Professional Conduct (available www.naasp.org.uk). This takes into account knowledge, skills, responsibility and accountability (DH 2006).

Managerial Issues

NAASP recommends that the SCP role is strategically planned for and that employers are able to sustain the position. Anecdotal evidence has suggested that in some instances individuals have undergone education and training for this role only for the employer to state that this is no longer a viable option. This is a considerable waste of time, energy and money and does not put these expanded roles in a good light.

 

NAASP also recommends that the role is appropriately risk assessed and that individuals practicing as SCPs have an up to date job description in line with the Knowledge and Skills Framework and receive the appropriate remuneration.

 

NAASP strongly recommends that individuals practicing as SCPs keep a log book of their clinical activity. This will ensure that all activities are correctly recorded and documented according to the individual’s professional regulating body. This will help to ensure public protection.  NAASP further recommends that patients are informed of who is providing their treatment, where this is not a medically qualified person, ensuring patient choice.

Indemnity Insurance

The SCP is accountable for their practice. Whilst SCPs are employees they would normally be covered by the employer’s vicarious liability. However SCPs who practice independently may not be covered vicariously. SCPs undertake a number of clinical interventions and as such NAASP strongly recommends that all SCPs have professional indemnity insurance. This can be obtained through organisations such as the Medical Protection Society and Medical Defence Union.

Conclusion

There are now a number of educational institutions who are providing the education and training for this role based on the Curriculum Framework (DH 2006). NAASP has recognised that there are now a number of individuals who are practicing and employed as SCPs throughout the UK. To date, NAASP is not aware of any other position statement that will help guide SCPs in their practice. As with the recently published ASP position statement, NAASP felt it timely that it should also provide its membership with a statement regarding the role of the SCP. As a proactive association NAASP hopes this position statement will provide information and guidance not only to its members but individuals who wish to be SCPs in the future and also to the general public.

References

Department of Health (1998) A First Class Service: Quality in the New NHS. HSC 1998/113

Department of Health (1998) Working Time Regulations: Implementation in the NHS. HSC 1998/204

Department of Health (2000) A Health Service for all Talents; Developing the NHS Workforce

Department of Health (2000) The NHS Plan: A Plan for Investment, A Plan for Reform.

Department of Health (2004) Modernising Medical Careers: the Next Steps.

Department of Health (2006) The Curriculum Framework for the Surgical Care Practitioner.

Health Professions Council (2008) Standards of Conduct, Performance and Ethics. HPC, London

National Association of Assistants in Surgical Practice (2005) Definition Surgical Care Practitioner www.naasp.org.uk

National Association of Assistants in Surgical Practice (2008) ASP Position Statement  www.naasp.org.uk

National Association of Assistants in Surgical Practice (2009) Voluntary Code of Conduct  www.naasp.org.uk

Nursing and Midwifery Council (2008) The Code: Standards of conduct performance and ethics for nurses and midwives. Nursing and Midwifery Council, London.

UKCC (1992) Scope of Professional Practice. UKCC, London