Task transfer: the view of the Royal Australasian College of Surgeons

John P Collins, David J Hillis and Russell W Stitz
Med J Aust 2006; 185 (1): 25-26. || doi: 10.5694/j.1326-5377.2006.tb00445.x
Published online: 3 July 2006


International experience

In the Western world, some tasks in surgery previously considered the province of medical graduates are now shared by others. Nurse endoscopy clinics have been successfully implemented,3,4 and have become a vital component of screening and diagnostic services. Historically, surgeons have been assisted in theatre by nursing staff and by medical graduates, including trainees. The role of the nurses has evolved from a passive function to one of undertaking some degree of intervention under appropriate supervision, as exemplified by the roles of surgical physician assistants in the United States5 and surgical care practitioners in the United Kingdom.6 The success of a pilot project in Oxford, in which a non-medically qualified member of the surgical team harvested the long saphenous vein for coronary artery bypass grafting,6 led to the development of similar roles in some other surgical specialties. In the UK, the curricular framework for the surgical care practitioner has been developed by representatives of the Royal College of Surgeons of England and the National Association of Assistants in Surgical Practice.7 The program is aimed at non-medical practitioners who will not only manage the clinical care of patients but will also perform technical and operative interventions under defined levels of supervision by surgeons.8 Not surprisingly, these developments have not been supported unanimously.9

Important considerations

Considerations to be broached in any discussions of transfer of tasks within the surgical environment include the tasks being transferred; the possible impact on educating tomorrow’s surgeons; the recruitment, training and supervision of involved individuals; the importance of medical education in decision making; where responsibility will lie, particularly with respect to the judgement needed to outline a management plan; and, most importantly, how the public can be assured that their management remains the responsibility of surgeons. Some of these considerations are discussed below.

Public rights and perceptions

A further difficulty lies in what members of the public perceive, and their right to clear information. Job titles and nomenclature need to be explicit and clear, or patients will not be aware of who is or is not medically qualified. In an English survey of patients attending outpatient clinics, 82% believed incorrectly that surgical care practitioners were medically qualified.15 In any event, “patients must know who they are seeing, what their role is in the surgical team and which qualifications they possess”.16 This is an essential part of preserving the trust patients have in their health care professionals. It is therefore vital that further discussions on the role and title of non-medically qualified health care professionals include patient and community representatives.

  • John P Collins1
  • David J Hillis2
  • Russell W Stitz3

  • Royal Australasian College of Surgeons, Melbourne, VIC.


  • 1. English T. Personal paper: medicine in the 1990s needs a team approach. BMJ 1997; 314: 661-663.
  • 2. Van Der Weyden MB. Debating health workforce innovation. Med J Aust 2006; 184: 100-101. <eMJA full text>
  • 3. Cash BD, Schoenfeld PS, Ransohoff DF. Licensure, use, and training of paramedical personnel to perform screening flexible sigmoidoscopy. Gastrointest Endosc 1999; 49: 163-169.
  • 4. Goodfellow PB, Fretwell IA, Simms JM. Nurse endoscopy in a district general hospital. Ann R Coll Surg Engl 2003; 85: 181-184.
  • 5. Blumm RM, Condit D. Surgical physician assistants help solve contemporary problems. Bull Am Coll Surg 2003; 88: 14-18.
  • 6. The Royal College of Surgeons of England. Assistants in surgical practice: a discussion document. London: RCSE, 1999.
  • 7. Department of Health. The curriculum framework for the surgical care practitioner. London: Department of Health, April 2006. Available at: (accessed May 2006).
  • 8. de Cossart L, Graham R. Curriculum development for surgical care practitioners. Ann R Coll Surg Engl 2004; 86 Suppl: 354-355.
  • 9. Samuel AW. Surgical care practitioners: the case against. Ann R Coll Surg Engl 2005; 87 Suppl: 241-242.
  • 10. Royal Australasian College of Surgeons. Activities report 2005. Available at: (accessed May 2006).
  • 11. Shannon C. Doctors object to a wider role for surgical care practitioners. BMJ 2005; 330: 1103.
  • 12. Kingsnorth AN. Training SCPs to perform inguinal hernia surgery. Ann R Coll Surg Engl 2005; 87 Suppl: 242-243.
  • 13. Playdon ZJ, Goodsman D. Education or training: medicine’s learning agenda. BMJ 1997; 314: 983-984.
  • 14. Who is a surgeon [editorial]? Lancet 1995; 345: 663-665.
  • 15. Moorthy A, Grainger J, Scott A, et al. Surgical care practitioners — a confusing and misleading title. Ann R Coll Surg Engl 2006; 88 Suppl: 98-100.
  • 16. The Royal College of Surgeons of England. Surgical care practitioners (in response to the front page article in The Independent on 6 December 2004). London: RCSE, 6 December 2004 (available from the College).


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.