The care curriculum

The RCSEd and RCSEng have developed the SCP curriculum and register, as Bill Allum and Charles Auld explain

The development of multidisciplinary team working is essential to delivering high-quality and safe patient care. Medical associate professionals (MAPs) are nonmedically qualified practitioners who work within multi-professional teams, and the group encompasses physician associates (PAs), anaesthesia associates (AAs) and surgical care practitioners (SCPs).

The regulation of these professional groups was set out by the Department of Health and Social Care in its publication entitled The regulation of medical associate professionals in the UK in 20191 Although statutory regulation was granted for PAs and AAs, with the General Medical Council (GMC) as the regulatory body, the UK Government stated that it would only consider statutory regulation for SCPs if recruitment to SCP training posts was open to a direct-entry route – that is, for those SCPs not from a healthcare background. In response, the options for this route are actively being explored by the SCP National Advisory Committee at Health Education England (HEE).

In a previous edition of Surgeons’ News2, we addressed the need for better recognition and improved regulation of SCPs. This included the need to develop a voluntary yet formal register of SCPs similar to the Physician Associate Managed Voluntary Register (PAMVR), implemented by the Faculty of Physician Associates for PAs, which has been crucial to the approval of statutory regulation

(see www.fparcp.co.uk for more information). More recently, the Royal College of Anaesthetists (RCoA) has set up a voluntary register of AAs (see www.rcoa.ac.uk).

Working Together

To support this case for statutory regulation and to demonstrate a commitment to SCPs, the Royal College of Surgeons Edinburgh (RCSEd) and the Royal College of Surgeons of England (RCSEng) agreed to work together on a bi-collegiate basis and as equal partners. As the surgical bodies currently championing and supporting the work of the extended surgical team (EST), they formed the joint EST Project Board with two principal aims:

To revise and update the SCP curriculum, previously owned by the RCSEng, for the MSc in Surgical Care Practice to support the postgraduate training for SCPs and provide a future route to facilitate direct entry to SCP roles.

To develop a managed voluntary register (MVR) for SCPs.

The two work streams had representatives from both surgical colleges, HEE, SCPs from different surgical specialties and programme directors from higher education institutes running the MSc programme, as well as representatives from governance and the legal profession.

Curriculum Framework

SCPs have become well established in healthcare organisations and this has been shown to enhance the capability of the surgical team to develop professionally. They support and enhance training opportunities for surgical trainees and provide surgical services that complement the medically trained workforce.

The educational governance of SCPs has expanded since the first SCP curriculum was published in 2006. In addition, there have been significant changes to curricula following the GMC publication of Excellence by design (GMC 2017)3 , which sets the standard for postgraduate medical curricula, with inclusion of practice-based outcomes, as well as defined evidence of practising professionally.

The 2022 SCP curriculum revision incorporates the principles of Excellence by design by using workbased assessments to provide evidence of capability in practice. The revision has built on the 2014 version, providing generic and specialty-specific knowledge, and clinical and technical skills. A key component of this curriculum revision is the inclusion of those capabilities that define the professional role of an SCP alongside the clinical and technical training.

These are based on the four pillars of advanced practice defined in the

HEE’s Multi-professional framework for advanced clinical practice in England4:

Management and leadership

Professional values and behaviour

Education and training

Audit and research

The curriculum is designed to be taught over two phases (phase one: generic; and phase two: specialtyspecific topics) and usually to be completed in three years. This design allows flexibility of entry to enable recognition of previously gained knowledge, skills and experience. This complements the option of direct entry from a non-healthcare background or from an established non-medically qualified background.

The components of the assessments have been designed to meet the requirements of the higher education institutes that offer the MSc in Surgical Care Practice. It is expected that SCPs will advance their career with appropriate professional development to work independently within the surgical team. The pluri-professional skill set learnt from the course will prepare them for pursuing more advanced practice should they so wish.

The RCSEng and RCSEd wish to ensure that a qualified SCP is educated to a standard approved by the colleges.

The combination of a full curriculum revision to meet the current GMC standards and the development of an MVR are consistent with ensuring a highquality, well-qualified practitioner who can work within the surgical team and gain great job satisfaction in their professional role.

Register Benefits

References

1. The regulation of medical associate professions in the UK. www.gov.uk, 2019.

2. Surgeons’ News, Mar 2020: 32–33.

3. Excellence by design. GMC; 2017.

4. Multi-professional framework for advanced clinical practice in England. 2017. www.hee.nhs.uk

Although an MVR is not a compulsory requirement for SCPs, it is the official register of SCPs held jointly by the two surgical colleges. Appearing on the register is an asset to individual practitioners as it demonstrates to their peers, employers and patients that they are appropriately qualified and working to the standards expected by the two surgical colleges.

The register will set the standards for postgraduate education and training, enhance the credibility of the SCP among their peers, employers and patients, and advance the case for statutory regulation by the GMC.

Inclusion on the register is based on three entry points (see ‘MVR routes of entry’, below) reflecting

MVR routes of entry

1 An SCP with a qualification aligned with the SCP Curriculum Framework 2022, that is, an MSc/PGDip in Surgical Care Practice that is aligned with the SCP Curriculum Framework.

2 An SCP-in-training, who is enrolled in an SCP Programme aligned with the SCP Curriculum Framework 2022.

3 An established SCP fulfilling a relevant academic, clinical or training role who does not hold the approved qualification, but can provide evidence of working as an SCP.

the various levels of academic qualification and experience, as well as the inclusion of SCPs in training. The eligibility criteria and application process are set out on the MVR website at www. scpregister.org

SCPs must also remain in good standing with their regulatory body and commit to meeting the ongoing CPD requirements.

In time, the information held on the MVR will allow the colleges to provide the necessary guidance for the SCP community to support appropriate job plans and structured CPD in order to enable SCPs to perform their duties to the highest standard.

Launching The Mvr

Early access to the Curriculum Framework and MVR was available from October 2022 to higher education institutes that deliver the MSc in Surgical Care Practice and those affiliated to the RCSEd Faculty of Perioperative Care, Associate Members of RCSEng, and members of the Association of SCPs (AoSCP) and the Association of Cardiothoracic SCPs (ACTSCP).

As a member benefit, those affiliated to RCSEng or RCSEd through either the RCS Associate Membership or the Faculty of Perioperative Care can join the MVR at no cost. For all others, an annual fee of £25 applies.

To find out more visit: www. scpregister.org or contact scpmvr@rcsed.ac.uk

The EST Project Board, which will continue to work together on further projects for the benefit of SCPs, would like to thank all those who contributed to the development of the curriculum and MVR. In particular, they would like to thank HEE for its financial support towards the MVR development costs.