Key Principles of the Surgical Care Team

The following principles support the RCS’s vision for developing the surgical care team:

1. There is a need for change to traditional workforce models of healthcare delivery.
2. Well-managed use of the surgical care team can improve patient experience, service delivery and quality of training.
3. Healthcare providers should develop a strategic plan for developing and recruiting these roles.
4. When modelling the surgical care team, one size does not fit all, and any recommendations have to be adjusted to meet local need.
5. The structure of the surgical care team should be determined with the intent to meet the needs of patients by improving patient care and promoting prompt access to safe services.
6. The definition of extended roles and proposed scope of practice is not aimed at fixing and restricting the remit of these roles, but rather at promoting clarity of competencies. It also facilitates delegation and limits risks to patient safety.
7. The introduction of extended roles into the service can be flexible and varied. Job plans and descriptions can be adapted within the broader scope and competencies of each defined role to meet the demands of the service.
8. Extended practitioner roles complement, but do not replace, surgeons or medical staff. They enhance the capability of the surgical team and should evolve together within the team. Their educational development should not compromise the training of future surgeons.
9. The implementation of these roles should cover the whole surgical pathway for surgical patients, from admission to discharge, and in both the operating and non-operating environment.
10. Extended roles should be fully integrated into the surgical team with dedicated job plans, rather than simply “fill gaps” in the service in an ad hoc manner. The model for developing extended surgical roles should be team-based rather than task-based.
11. Extended roles in the surgical team should be able to carry out medical work within defined boundaries. It is acknowledged that there will be some overlap of competencies and activities between extended roles, trainees and non-training grade surgeons who make up the surgical team. Consultant leadership is crucial to ensure well-managed use of each practitioner’s different skillsets and a balanced allocation of activities and opportunities between trainees, extended roles and other professional staff.
12. Due care should be given to ensure that the training of extended roles does must not come at the expense of surgical trainees’ access to training opportunities. The primary driver for service design must be developing the best model for delivering high quality patient care.
13. Extended roles should undertake both clinical and administrative work.
14. Extended roles should work within a medical management model in which they are clinically responsible to a consultant.
15. The split between service and training is not sharply defined. The educational value of tasks will vary based on experience and level of training so the aim to create a closer link between the two through an intelligent allocation of tasks and a balanced share of the workload.
16. There should be clarity and consistency of roles and titles, educational requirements and scope of practice. Training and assessment of these roles should be standardised and eventually lead to admission onto a national register.
17. Consultant leadership and robust clinical governance frameworks alongside a culture that supports training and professional development are crucial for the sustainability and success of the surgical care team.
18. It is accepted that practitioners who trained prior to the current regulations regarding training, or in other parts of the world, may have equivalent skills and capabilities to current members of the surgical care team. Further work will be needed to determine the right processes for assessing equivalence.
19. The practice of extended roles should be monitored and regulated. The consultant surgeon remains responsible for the overall management of the patient’s care.

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