AN army of highly-trained “super nurses” could be brought in to carry out vital examinations usually only performed by doctors, in the latest move to increase the number of patients the NHS can treat.
NHS Lothian is exploring whether more advanced nurse practitioners, who must be able to display expert knowledge and extensive experience, could be drafted in and used as an alternative to consultants to carry out diagnostic endoscopies.
The health board has seen a huge increase in demand for the procedures, which allow internal examinations using a camera on the end of a tube and can pick up a series of life-threatening conditions, due to an aging population and the Scottish Government’s bowel cancer screening programme.
The health board already employs three nurses who carry out the procedures, seeing 2700 patients a year between them, but the programme could be rolled out more widely to drive down waiting lists and free up consultants to work on more complex cases.
The plan was broadly welcomed, but there were calls for safeguards to be put in place to ensure patient safety.
RCN Scotland Associate Director Norman Provan said endoscopies could be carried out safely and effectively by nurses with the right training and skills, but warned pay must reflect increased responsibilities.
Consultants receive annual basic pay of up to £100,000, with the opportunity to earn tens of thousands more in incentivised payments, while advanced nurse practitioners receive salaries of around £40,000 per year. Mr Provan said: “This is not a procedure that absolutely needs a medical consultant to carry it out. If this means more patients are able to be diagnosed and treated quicker, this is a benefit.
“It is important that advanced nurse practitioners carrying out endoscopies have their jobs evaluated correctly under Agenda for Change, the UK-wide NHS pay scheme, so they are paid at the right level for the role they are carrying out.”
Advanced nurse practitioners have also been sought by NHS Lothian to ease staffing pressures in A&E, as well as on paediatric and neonatal wards.
Labour Lothians MSP and shadow health secretary Neil Findlay said: “Any additional capacity to tackle waiting times is welcome as long as patients come first and their procedures are carried out safely. But giving Advanced Nursing Practitioners extra responsibility has to be properly thought through.”
While endoscopy waiting lists have come down significantly over the past year, largely as a result of extensive use of the private sector, they rose sharply in August due to clinicians going on holiday.
The British Medical Association Scotland said that doctors regularly worked with others to provide care but that it was important health professionals knew their limitations.
A spokeswoman said: “Although care that only doctors can deliver should only be delivered by doctors, there are many things that are currently done by doctors that need not be. All healthcare professionals, including doctors, should be aware of the limits of their competence and always practice within them.”
Sarah Ballard-Smith, NHS Lothian’s nurse director, said: “NHS Lothian employs three advanced nurse practitioners who contribute to the diagnostic endoscopy service. They provide a full range of diagnostic services including colonoscopies and endoscopies. However, consultants are still required to undertake more complex and specialised procedures.
“We are currently reviewing the demand and capacity for the service and this includes the possibility of recruiting more advanced nurse practitioners in the future.”
ERI gears up for more patients
THE recruitment of highly-skilled nurses is one of several steps health bosses have taken to increase the number of endoscopies that can be carried out.
Extra capacity has been put in place at the Royal Infirmary in the summer, which is expected to allow an extra 550 patients a year to be treated.
Work is under way to bring in another five clinics, which will mean an extra 1375 patients every year will be seen.
While the majority of patients who need diagnostic endoscopies receive them within the target of six weeks, some have to wait a bit longer.
A year ago, it emerged that more than 2000 people were overdue for surveillance endoscopies, which are offered to those with an increased risk of bowel cancer.