Statement of the Association of Laparoscopic Surgeons of Great Britain & Ireland (ALSGBI), the ALSGBI Academy and the Association of Laparoscopic Theatre Staff (ALTS) on the scope of practice of Surgical Care Practitioners (SCP) undertaking surgical procedures
The ALSGBI is uniquely positioned to comment on the recent publication in the Annals of the Royal College of Surgeons of England (RCS) describing a series of Laparoscopic Cholecystectomies (LC) carried out by an SCP at a general hospital in England. The ALSGBI represents more than 700 surgeons, including the ALSGBI Academy of trainees, who carry out minimally invasive (laparoscopic and robotic) surgery in Great Britain and Ireland as well as theatre staff (Association of Laparoscopic Theatre Staff – ALTS). We work with the Association of Surgeons in Training (ASIT) who have a seat on our Council.
The paper described surgical outcomes in 170 patients undergoing LC from a pooled list of low-risk cases with all operations supervised by a surgeon from Core Trainee (YR 3) to Consultant Surgeon. Informed consent and ethical approval for the study was obtained. The study is a small, single centre experience.
This paper highlights the need for reasoned debate from all stakeholders about the future provision of surgical care in Great Britain and Ireland taking into consideration:
- the clear guidance given in the 2022 publication by the Royal College of Surgeons of England and the Royal College of Surgeons of Edinburgh (The Curriculum Framework for the Surgical Care Practitioner)
- the need to support surgical trainees at a time when opportunities for hands on experience are scarce
- the need to build a robust workforce that embraces and values SCP’s in their agreed roles working within their scope of practice
- medico-legal implications and transparent informed consent
The Council of the ALSGBI does not support SCPs carrying out LC because:
- LC is a major surgical procedure and is not in the agreed RCS scope of practice for SCPs
- there is an inevitable impact on training opportunities for SAS doctors and surgeons in training who are on a defined training pathway to carry out these index surgical procedures
- there appears to be minimal benefit in workforce deployment if a doctor is required to be constantly supervising the SCP
- potential medico-legal implications
- patient knowledge and consent in the context of the Montgomery test is unclear
The ALSGBI is committed to developing, delivering, and monitoring the minimally invasive training of young surgeons and SAS doctors in Great Britain and Ireland. This is an absolute and unequivocal priority. We are also committed to developing first class surgical care teams and supporting SCP’s along with all our theatre staff working within their clearly defined roles. We acknowledge the important role that SCP’s play in the care of surgical patients and their contribution to high quality care. Our commitment as an Association is to support and develop the surgeons of the future.
