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Last Updated: Monday, 5 April, 2004, 01:54 GMT 02:54 UK
Training nurses to do surgery
Nurses' roles are expanding
Nurses are being trained to carry out surgery, including hernia and gynaecological operations.

BBC News Online looks at the case for breaking down traditional boundaries in the NHS.

A nurse in Plymouth is training to perform hernia operations usually carried out by surgeons.

Now three months into her training, she is one of a growing group of "surgical practitioners" at 24 sites across England who are learning to wield a scalpel.

Professor Andrew Kingsnorth, professor of surgery at Derriford Hospital, who is leading the scheme in Plymouth, said there was resistance from some of his medical colleagues but said the public should not be concerned.

He said: "The traditionalists and fairly conservative people may feel initially that this is too radical and traditional ways of doing things are the best.

"Nevertheless, these programmes are just designed to show how things can be done. If the outcomes are inferior in any way, they will not be rolled out."

I don't think people should be alarmed
Mr Hugh Phillips, Royal College of Surgeons
Other surgical areas now being tackled by healthcare workers from nursing and support backgrounds include vascular surgery, orthopaedics, ophthalmology and gynaecology.

Introducing a surgical practitioner at Cheltenham and Gloucester has reduced the average time for bilateral varicose vein surgery there by 30 minutes, according to the government's Modernisation Agency.

The agency, which is behind the moves to increase the role of nurses and others, is also claiming surgical practitioners have allowed the two week target for treating bladder cancer to be met in Milton Keynes.

Nursing organisations are all for the changes, saying they are a good way of improving careers for nurses and so keeping them in the NHS.


John Beesley, lead professional officer at the National Association of Theatre Nurses, said: "This is very exciting. It gives us the opportunity to unleash our potential."

He said the plans signalled the end of "tribalism" in the health service.

Nurse surgeon schemes
Cheltenham - vascular surgery
Milton Keynes - urology
Birmingham - general surgery
Central Middlesex - minor procedures
Liverpool - orthopaedics
Manchester - ophthalmology
Morecambe Bay - colorectal
Manchester - gynaecology
Plymouth - hernias
The Royal College of Nursing is also in favour, though Linda Summerbell at the college stressed nurses would have to prove they were up to the roles they were taking on.

"It is important they achieve the competences required of them," she said. "The training programmes I have seen are to degree level and they are supervised by consultant surgeons."

The scheme is not without its critics. One doctor, writing on a web forum for the medical profession, said: "Nurse = nurse, not mini-doctor. Nurses should stick with what they are trained to do."

And some surgeons have said that while they are not against the principle of nurses doing this work, they are concerned about the impact on junior doctors' training.

The fear is that trainee doctors will not have the same opportunities to build up the experience they need if other staff are doing the surgical work.

Mr David O'Regan, a consultant surgeon in Leeds and organiser of an annual competition to find the best surgical trainers, said he was initially sceptical about surgery practitioners but had been convinced of their benefits after working with one.

The Royal College of Surgeons, which is drawing up the training curriculum for these surgical assistants - as it prefers to call them - is supporting the moves, though it is keeping a careful eye on them.


It says the initiative is necessary to meet the demands of European limits on working hours, but has concerns that the practitioners are not subject to regulation in the way that either surgeons or nurses are.

Mr Hugh Phillips, vice-president of the college, said: "Nowadays surgery is delivered in teams, the leader of which is the surgeon. Non-medically qualified staff do not deliver the whole care, but they can do part of it if they have proven competence and are subject to assessment continually."

A surgeon would always be available and the role would be limited to certain areas, he said. Surgical assistants would not end up doing complex heart operations or face reconstructions, for instance.

"I don't think people should be alarmed," Mr Phillips said.

Professor Kingsnorth stressed patients should always be kept informed of who is performing their surgery. But he said: "You may be surprised to know that patients are quite happy. They take it for granted that the person who is going to do their operation is fully trained.

"They are more concerned about how long they will have to wait, how long it will take to recover and when they can get back to work."

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