Nurses may operate with patients' consent

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Doctors were reminded yesterday to follow strict rules when allowing nurses and other non-medical staff to carry out simple operations.

A report from the British Medical Association said it was important for the different specialist professions to agree clear guidelines on how surgical procedures can be conducted by staff who are not doctors.

The BMA's joint consultants' committee (JCC), which represents all the Royal Colleges, said tasks should only be given to staff who are appropriately trained and supervised, and in all cases the patient must be kept informed.

The JCC said the guidelines should provide a framework designed to "set and maintain the necessary standards of education, limits of responsibility and scope of practice to ensure both satisfactory service and patient safety".

A patient's consent had to be obtained before a non-medically qualified health practitioner could perform an operation.

The JCC also said:

The approved list of minor surgical procedures that a non-medically qualified person may perform must be precisely defined and not changed without agreement.

Non-medically qualified practitioners trained in surgical techniques should be specially registered and supervised under an extended disciplinary code.

A non-medically qualified member of staff undertaking surgery should be under the overall supervision of a doctor.

Any patient being operated on by a non-medically qualified member of staff must always be informed of the training and status of the practitioner, and sign a consent form before the procedure goes ahead.

Sir Rodney Sweetnam, president of the Royal College of Surgeons, said: "Animals are protected from having any operation on any part of their body than by anyone other than a fully trained vet. But the public does not have the same protection. It's an anomaly."

Professor Sir Norman Browse, chairman of the JCC, said: "We have become concerned at a number of non-medically qualified staff have been expanding their duties and carrying out tasks which they are not strictly qualified to do.

"Our concern is not that they should not do these tasks, but if they do expand their role, they must be properly trained, follow a strict protocol and be supervised."

Britain is the only country in Europe that does not have strict regulation governing this area of medicine.

The doctors denied that the delegation of some minor operations was prompted by staff and financial shortages. But Dr Michael Brindle, President of the Royal College of Radiology, said that the problem should be seen "against the background of an increasing demand for medical work, which exceeds the capacity of the medical workforce".

They also denied that theguidelines constituted protectionism, designed to safeguard surgeons.

Liz Jenkins, director of policy and practice at the Royal College of Nursing, said: "It is both welcome and relevant for nurses to perform medical procedures, where they have been given appropriate training."