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Surgery: more development of non-medical practitioner roles needed to meet demands

Surgery could miss out on the valuable skills non-medical practitioners, such as physician associates, surgical first assistants and advanced nurse practitioners, bring to the surgical workforce if more focus isn’t given to developing their roles.

That’s the message from the Royal College of Surgeons (RCS) which says more must be done by the NHS, government, and medical professionals to support them.

In surgery, the RCS says surgical care practitioners should be better aligned with the surgical profession, with their identity seen as part of the surgical team.

A new RCS report, A question of balance: The extended surgical team, examines new surgical workforce models being used at eight NHS hospitals to establish the role the extended surgical team is currently playing and how it can help improve the care patients receive in the future.

The report, which has been co-funded by Health Education England (HEE), also highlights how extending the role of non-medical staff can free up junior doctors to help them focus on their training.

Non-medical practitioners, who do not regularly rotate through different organisations and who often build up significant expertise in their areas of work, can improve the co-ordination of patient care as they can provide a link between patients, consultants and trainees.

There is also benefit, the report says, to having highly experienced and trained non-medical practitioners on hand to answer questions and provide support.

They provide a familiar face, help establish good relationships, and are key to developing trust between patients and staff.

Mr Ian Eardley, Vice-President of the Royal College of Surgeons and a consultant urologist, said: “Surgeons support non-medical roles being more deeply integrated into surgical and medical teams. At the sites we visited many were highly trained and experienced practitioners helping to provide better continuity of care for patients and improve surgical training for junior doctors.

“That said, if the NHS, government and medical professionals don’t do more to properly plan how these roles are used and find ways to better support them in their careers, the opportunity to use them to their full potential could be missed. Practitioners we spoke to often lacked peers to share ideas with and felt they played an isolated role in the wider team.

“If we as surgical leaders don’t do more to align them with our profession, making them feel part of the surgical team, the benefit this vital workforce brings to patient care will not be fully realised.”

The report says there are a number of challenges to making the most of non-medical practitioners in the extended surgical team, including the significant variation of what they do in different hospitals, the level and nature of postgraduate qualifications, whether or not they can prescribe, and even the plethora of job titles being used which is confusing to patients.

The RCS says work must be done to enhance the professional aspects of training for non-medical practitioners.

It also says standards should be developed to guide the evolution of new non-medical roles within surgical specialties.

Currently, anyone can call themselves a physician associate and unless, or until, statutory regulation is introduced for these practitioners, it falls to employers to navigate the limitations around prescribing, accountability, indemnity arrangements, and the qualifications they look for.

HEE should consider whether physician associates are being trained in sufficient numbers to support the surgical workforce, and whether clinical placements are giving sufficient exposure to surgery to attract physician associates into surgical departments once qualified.

The report identified a number of ways that well managed use of the extended surgical team can support doctors and enhance training, including:

  • Enabling doctors in training to leave the wards to attend teaching, outpatient clinics or theatres.
  • Allowing trainees to stand in the best vantage point in theatre for learning.
  • Helping new doctors settle into rotations more quickly.
  • Reducing the occasions that higher surgical trainees are called out of theatre.
  • Helping with the administrative burden.
  • Giving consultants’ confidence to step out of the room and leave senior trainees to operate with a skilled assistant.

The authors identified no basis for concern from the eight sites they visited that greater use of non-medical practitioners dilutes surgical training opportunities.

Mr Johnny Mathews, one of the report authors and an orthopaedic trainee, said: “Surgical rotas are becoming increasingly difficult to fill, with patient care maintained by the goodwill and hard work of those junior doctors present, often at the detriment to their own training.

“The extended surgical team can realise its potential when designed to complement rather than substitute junior doctors, allowing better allocation of tasks and an opportunity to really improve surgical training alongside patient care as we have seen in the various case studies in the report.

“To achieve this it is essential that these roles are properly planned according to local need, and are implemented in the presence of strong consultant leaders who support a culture that prioritises training as well as service.”

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