by: Gabriel Campaner
My name is Gabriel. I came to the United Kingdom 11 years ago and currently work as a Surgical Care Practitioner for Trauma and Orthopaedics specialising in Acute Musculoskeletal Knee pathologies and lower limb arthroplasty in a district general hospital in the East of England.
When I first started working as a scrub nurse, it immediately became apparent that Trauma and Orthopaedics is not a subspecialty most people willingly choose to work in. The hours are long, instrument hefty and numerous, and equipment can be complex and arduous. Throughout these years, the increase in hospital activity has left the NHS perpetually “underfunded, overstretched and short of physicians ”. For care to continually be accessible, the emphasis on extended roles such as Surgical Care Practitioners have become increasingly relevant in the modern surgical team.
The Royal College of Surgeons define Surgical Care Practitioners (SCPs) as non medical practitioners who are employed as part of the extended surgical team, working under the supervision of a consultant supervisor. They are trained to perform most aspects of the roles that are traditionally performed by doctors, in order to ensure that the patient’s surgical experience is safe and efficient. Being a SCP means bridging the gap between the traditionally disease-oriented medical perspective, and the holistic, patient centred nursing paradigms. Furthermore, since surgical trainees (registrars) often do 6-monthly rotations, SCPs can be considered one of the constant components which provide a sense of permanency to the team, thereby ease the transition between medical rotations and help ensure stability within the team.
As a SCP, the type of job, and workload during the week varies, depending on theatre availability, caseload, and in a broader sense, department and trust wide needs. In general however, these could be subdivided into Theatres, Clinic, and Admin/SPA Sessions.
Involves mostly making sure that the patient’s surgical pathway is safe and efficient throughout the day - from pre operative checks in the ward, perioperative assisting in theatres, and ensuring patients are recovering well post operatively.
1. Preoperative rounds – independent or supplementary reviewing, consenting, marking of patients before surgery. The time it takes for preoperative rounds varies depending on how well the patient is and may take a little longer if the patient has medical problems or other concerns that urgently need attention.
2. Intraoperative assisting – Includes first or second assisting for major operations.
First assisting - involves patient positioning, retracting etc. However, the main difference between a Surgical First Assistant (SFA) is that SCPs are trained to perform surgical interventions, hence apart from suturing and local infiltration, they are allowed to perform part, if not the most of the operation depending on the SCP’s competence, and supervisory arrangement.
Second assisting - involves providing learning opportunities for surgical trainees to perform proximally supervised operating, which means, registrars, middle grades, and fellows can operate independently with the SCP as first assistant, without the consultant being scrubbed, or physically present in theatre. Therefore, the limited learning opportunities are maximised as trainee surgeons are allowed to operate at their own pace in a safe learning environment by having an assistant who not only fully understands the nuances of a specific operation but also capable of providing some support when necessary.
3. Postoperative rounds – independently or supplementary assessing patients post operatively. Some trusts include non-medical prescribing in their SCP training, as well as specific subspecialty training in order to request diagnostic tests such as blood tests, ultrasound, xray, CT and MRI scans. Hence, necessary investigations can be carried out immediately, without having a doctor being physically present in the ward.
SCPs attend elective orthopaedic clinics independently or under proximal supervision which includes new patients and follow ups. The clinic may include new patients with orthopaedic problems that were referred from the community (physiotherapy, GP, musculoskeletal services) or from the hospital (A&E, ward, & referral from other subspecialties), patients currently undergoing further investigations and post operative follow ups.
The allocated sessions provide the SCP protected time to manage non urgent jobs that have not been completed throughout the week. These may include helping organise loan instruments and equipment for specific operations, as well as following up patient radiographs, MRI, CT scans or other diagnostic blood tests. Clinical audits and research are also a crucial and constant part of the role. In orthopaedic surgery, every hip, knee, shoulder, spine, and ligament operation is logged into a registry which helps oversee outcomes nationally. Surgical Care Practitioners often oversee, or look after these essential registry pathways as they provide evidence based data across the country in terms of what techniques and implants work well for patients.
Expectations and Misconceptions
Although being widely prevalent in the UK for nearly three decades, SCPs are still a novel group of practitioners trying to find their feet whilst seeking their place and value in the overall echelons of the UK health care system. Many people do not know they exist, or understand the role scope and limitations. It is therefore understandable that doubts about nurses who “play doctor” can be viewed as controversial. There still remains contention and a mix in opinions in this matter both from patients and colleagues alike.
One common misconception which may need clarification is the belief that SCPs specifically train to become surgeons. Although there may be SCPs in the country who run their own minor theatre lists, on a regular basis as part of their job description, the Royal College of Surgeons stipulates non-medical practitioners like SCPs can perform surgical interventions, if deemed competent, and provided vicarious liability by the Trust. However, just because they can do it, doesn’t mean they should. Not if there are more experienced surgeons are available, and not if interferes with the training needs of registrars who require surgical experience. SCPs can become safe, efficient, and very competent operators, however they are not specifically trained to become, or replace surgeons. The SCP role spans the entirety of the elective patient pathway from initial presentation, surgical intervention, to discharge and as such - are trained to ease the burden at any point of the care continuum to address the patient and hospital needs.
Applying for an SCP Post
Any professional with a recognised regulatory body is able to apply for the Two Year Master’s Course. However, in order to pursue the SCP qualification, the employing hospital must agree to fund a two year training contract where the practitioner can work full time whilst being a part time student within the duration of the course. At the time of writing, there are currently only three universities in the United Kingdom who provide the Royal College of Surgeons accredited MSc for Surgical Care Practice Course.
Perhaps, the most important quality for this role is the ability to discern what one does not know. Although SCPs work within a similar structure as medical practitioners, one must realise that they are not doctors. SCPs are trained to supplement the capabilities of the surgeons, rather than replace them. Equally, understanding how one’s skill, experience, and expertise fit best in the team, perpetual conscientiousness, whilst remaining introspectively self-critical is essential. Whether SCPs are making a difference in the healthcare field, one can only hope so. They help relieve the enormous pressure to reduce patient waiting times by maximising hospital efficiency as they work alongside the extended surgical team (Consultant, Registrar/Middle Grade, plus SCP).
If you’re an experienced nurse or ODP and looking for an opportunity for career progression, and a compelling challenge, bear in mind - It is hard work! However, they say nothing in this world that’s worth having ever comes easy. The Choice is yours. Good Luck!