There have been many changes to the modern surgical team in recent years with most specialties employing non-medical practitioners (NMP) such as Surgical Care Practitioners (SCP) to deliver excellent care to our surgical patients.
The COVID-19 pandemic has resulted in significant challenges to surgical practice with postponement of elective operating, outpatient clinics and a reduction in aerosol generating procedures irrespective of the specialty. After qualification, SCPs for example, tend to work to a medical model of care with a similar work pattern as a ST3 trainee with their scope of practice being supervised by a consultant surgeon as their clinical supervisor. As SCPs are invariably from a nursing background this may be advantageous in the midst of a crisis, i.e. are they employed to work to a medical model of care or revert to a nursing model of care? How does this impact on their own training and ability to deliver the service to which they have been trained?
The Faculty of Perioperative Care (FPC) sent a short survey to senior SCPs across the specialties of Cardiothoracic, Orthopaedic and General Surgery to determine the challenges COVID-19 can pose with particular reference to their preparation for this outbreak, the need to redeploy to other roles and their ability to work within (or out with) their scope of practice. Although the lack of PPE and staff shortages due to sickness or isolation were uniformly reported, it was reassuring to hear that there had been good preparation with additional training sessions, educational videos including FFP 3 face mask and donning and doffing sessions being practiced widely throughout the UK.
There are many advantages of having experienced practitioners such as SCPs in the team in difficult times. Redeployment, dependent on their skills, to manage patients in the critical care setting appears to have been a common practice across the specialties. In Trauma and Orthopaedics, Frances Page, SCP in Basildon and Thurrock University Hospitals, reports that “in addition to supporting the trauma services, I have been involved in triaging elective clinics as well as expanding the virtual clinic model to assist the trauma referrals“. Adrian Jones, SCP in Norfolk and Norwich University Hospitals, past President AFPP, reports on the challenges of establishing a 24/7 team rota as a result of staff sickness and isolation but comments “this time of fearful preparation has been supported by amazing leaders, educators and clinicians who have gone above and beyond to prepare the team. “His own experience of working to a medical model of care ensures he is ideally equipped to be flexible, adding “will I be running a plaster room, supporting a minor injuries clinic or rostered into a surgical team next week?”
In General Surgery, Jenny Abraham, SCP/ACP University Hospitals Coventry and Warwickshire, has been instrumental in the amalgamation of ACP/SCPs into the surgical rota and reports on the difficulties of continuing cancer surgery in an ever changing environment. One can readily see the benefits of having qualified SCPs when they can be incorporated into a surgical rota in the emergency setting.
It is now well established that trainee SCPs must undergo a PGDip/MSc in Surgical Care Practice to become a qualified SCP. How has COVID-19 affected these students? I am most grateful to Bhuvana Krishnamoorthy, Programme Lead for MSc Surgical Care Practice Edgehill University, SCP in Cardiothoracic Surgery, for sharing the report “Covid-19 MSc Surgical Practice student survey”. At Edgehill, over 50% of students are following the Cardiothoracic specialty in both years of the course. It is evident from the survey that the majority of the students feel they will be unable to achieve the clinical hours required and that they will have insufficient time to complete written assessments by the allocated date. This has resulted in considerable anxiety with the majority reporting that they feel unsettled and upset. They wish an extension to their course.
These results have been supported by recent discussions between RCSEd and the Universities as it has become clear that: a) the required no of hours for outpatient/ward work and theatre sessions (11:00 hrs for each) could not be satisfied and b) the quality assurance involved in the summative assessments such as OSCE and written exams could not be attained during this crisis as online assessment is inappropriate. I am pleased to report that there is now an external examiner report confirming that there will be 3 month extension to their studies.
Finally, although the Faculty of Perioperative Care was set up to provide education, training and set standards for the advanced practitioner in surgery, it is important to highlight that the Faculty provides practitioners a home, an opportunity to network with similar minded colleagues but also to assist or provide external advice to practitioners. Within the Faculty Executive and the Advisory Board, we have senior surgeons and practitioners on these committees who can provide this.