Introduction to the Surgical Care Team Guidance
A significant contribution to patient care has been achieved through the development of the roles of non-medical practitioners who undertake a series of duties traditionally carried out by medical staff. These roles within the surgical team have become critical to the delivery of surgical services in many specialties.
For the most part, such roles perform activities that support the day-to-day care of the surgical patient at a competence level that lies from foundation to core training stages, with a few taking on responsibilities that would normally be carried out in the first specialty training years. The RCS A Question of Balance report (2016) suggests that the adoption of extended roles in medical services has been largely beneficial for patient care, training quality and the efficiency of the surgical team.
Benefits of the surgical care team can include:
- improving continuity of care and patient experience,
- improving service efficiency through better coordination of patient flow and the reduction of waiting times,
- increasing productivity and staff capacity by spreading the service workload across more members of the surgical team,
- improving the quality of training by allowing trainees to focus on activities with the greatest training benefit,
- supporting trainees to settle into their posts and providing them with informal training,
- reducing locum costs.
Effective use of the surgical care team can also help tackle the challenges and pressures currently faced by those delivering surgical services and surgical training, including:
- the increase in service workload and complexity of cases due to an ageing population with increasing comorbidities,
- the reduction of trainee numbers, especially in foundation surgical posts, alongside changes to working hours,
- the concentration of complex services to fewer specialist centres,
- the reduced exposure of trainees to common surgical conditions,
- the use of trainees to fill gaps in frontline services such as night rotas and provision of ward or theatre cover.
However, the development of such roles has emerged as an ad hoc way to address gaps and shortages in local services. This has led to variation around the training, scope of practice, autonomy and integration into robust governance structures of surgical care team members.
Such inconsistency can undermine the advantages of these roles. For example, uncertainty over the training and scope of practice of non-medical team members can create confusion as to what tasks and activities can be delegated to them and present potential risks for patient safety. The lack of strategic vision and planning of how these roles can fit into the wider service can also create resistance against their full integration into the team and cause unnecessary competition with trainees for training opportunities. Lastly, insufficient governance arrangements can undermine the long-term sustainability of extended roles and have significant impact on their retention and development.
It is crucial that there is a strategic, whole-system approach to planning and modelling the surgical care team if its full benefits for patients, training and the service are to be realised. This should include:
- Clarity about the nature of extended surgical care team roles, and the scope and limitations of their practice.
- Standardisation of training and competencies in a way that does not compromise flexibility of implementation at a local level.
- Consultant engagement and leadership of the development of surgical care team roles, in a way that considers how they are integrated within other roles within the team.
- Robust governance structures that include systematic recruitment and planning for these roles within the service, with provisions around accountability, management, assessment, development and career progression. The consultant responsible for the extended role (the clinical supervisor) is therefore ideally suited to line manage these roles.
Aims of this guidance
The surgical care team guidance aims to help employers, surgeons and other healthcare professionals develop models of care that utilise the surgical care team in a consistent manner. It sets out distinct extended roles within the surgical team, and outlines competencies, training and clear routes of entry into these roles. It provides guidance on how to lead a surgical care team as well as recommendations and resources for the clinical governance arrangements that can support a flexible modelling of the surgical care team that meets local needs. The ultimate aim of this work is to enhance the quality of patient care, patient experience and patient safety, to improve the effectiveness and efficiency of services, and to support the quality and experience of surgical training.