As an organisation focused on improving standards of surgical care and patient outcomes, the Royal College of Surgeons of Edinburgh (RCSEd) is extremely concerned about the recent publication in the Annals of the Royal College of Surgeons of England (RCSEng) (“Laparoscopic cholecystectomy performed by a surgical care practitioner: a review of outcomes”) detailing the experience of a Surgical Care Practitioner (SCP) performing laparoscopic cholecystectomies.
Bile duct injuries are one of the most common causes of litigation in this country and can be catastrophic for patients. Consequently, laparoscopic cholecystectomy should only ever be undertaken by medically-trained surgeons. As a Surgical Royal College, we ensure surgeons are trained to the highest standards and develop the requisite skills to undertake such high-risk and complex surgical procedures. This requires years of clinical training and rigorous assessment.
In addition, trainee and SAS surgeons are often not achieving the required number of supervised procedures to achieve their required competencies and we feel strongly that every effort should be made to maximise their training opportunities.
RCSEd acknowledges the critical role that all members of the Extended Surgical Team (EST) play in delivering quality care. SCPs are highly valued members of the EST and are an integral part of the modern surgical workforce, providing high-quality surgical services that complement the medically trained workforce. SCPs will have completed a primary healthcare degree and are regulated by their own professional body. They will also have completed a structured training program recognised by award of the MSc in Surgical Care Practice. The 2022 Curriculum Framework for the Surgical Care Practitioner clearly defines the clinical, technical, and professional competency standards for SCPs. This does not extend to SCPs performing complex high-risk surgery. Therefore, the RCSEd has serious concerns regarding the implications of this reported practice with respect to informed consent, patient safety risks, and associated medico-legal implications.
Patient safety remains an absolute priority for RCSEd. Over the coming weeks, we will work with sister colleges, specialist associations, and trainee organisations to continue to clarify the roles and scope of practices of the various members of the EST and ensure that NHS Trusts and Health Boards consistently implement these.