Mon Nov 30, 2015 11:15 am (PST) . Posted by:

I would be grateful for some brief comments re theatre assistants (yes / no answers will be fine!). We have had some questions raised around our use of assistants and it would be really helpful to know if we are an outlier.

1. Do you use theatre support workers (ie not nurses or ODPs and therefore not independently registered / regulated) as scrubbed assistants?

2. If so, how have they been trained?

a. In house informally?

b. In house with defined competencies, risk assessments and so forth

c. Formal external course

3. If external, was this through choice or because the Trust was mandated to do it?

4. If you use regulated professions (ie nurses / ODPs) to assist, have they been formally trained to assist - yes / no?

Thanks v much for any help offered!

Best wishes

Adam Brooks
Consultant Orthopaedic Surgeon
Associate Medical Director - Planned Care
Great Western Hospitals NHS Foundation Trust

Yes we do use them in Basingstoke.
4-5 of them (maternity leave..)
All ex ODP or nurses.
All formally trained externally. By choice & mandated.
Worth weight in gold.....!

Nigel Rossiter
Consultant Trauma & Orthopaedic Surgeon
Mon Nov 30, 2015 12:21 pm (PST) . Posted by:
Dear Adam
1 No
2 N/A
3 N/A
4 No
Best wishes
Guy Slater
MTW NHS trust
Mon Nov 30, 2015 1:06 pm (PST) . Posted by:
AdamWe use Advanced Nurse Practitioners who are all formally trained . We have an in-house training programme affiliated to university of Huddersfield where they go through formal competency based assessments. 1. No2. n/a3. n/a4. Yes

Mon Nov 30, 2015 1:07 pm (PST) . Posted by:
1 Not as assistants. We do have Band 4 HCAs as scrub staff.
2 N/A
3 N/A
4 Yes we have fully trained SCPs with post grad qualification and internally trained scrub band 5/6 first assistants.

David Gidden

> [Attachment(s) from Slater Guy (MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST) included below]
> Dear Adam
> 1 No
> 2 N/A
> 3 N/A
> 4 No
> Best wishes
> Guy Slater
> MTW NHS trust
Mon Nov 30, 2015 2:10 pm (PST) . Posted by:
John Radcliffe, Oxford

1) No

2) n/a

3) n/a

4) No

Mon Nov 30, 2015 3:29 pm (PST) . Posted by:




Alex Acornley


Tue Dec 1, 2015 12:32 am (PST) . Posted by:

1. No

2. n/a

3. n/a

4. They would have to have formal training.


Tue Dec 1, 2015 12:35 am (PST) . Posted by:

At STH we use staff nurses when required. Formal in house training scheme and annual updates. No Support workers scrub.


We use Advanced Nurse Practitioners who are all formally trained . We have an in-house training programme affiliated to university of Huddersfield where they go through formal competency based assessments.
1. No
2. n/a
3. n/a
4. Yes


Tue Dec 1, 2015 1:48 am (PST) . Posted by:

1 no

2 n/a

3 n/a

4 yes band 6, post grad course and internal competencies

steve scott
Tue Dec 1, 2015 3:08 am (PST) . Posted by:
1. Yes

2. a. no

b. no

c. Yes
3. Mandated

4. Yes, but many have simply had old competencies re-signed off by consultants

Mr Cefin Barton MB BCh, MRCS, FRCS(Tr&Orth)
Consultant Orthopaedic Surgeon
Clinical Lead in Trauma and Orthopaedics
Mid Cheshire Hospitals NHS Foundation Trust
Thank you very much to everyone who has responded, which gives me a useful snapshot and please don’t feel the need to send more responses (although if you are a TSW user, I would still like to know – by all means email me separately to avoid clogging everyone’s inboxes).
In summary:
Of 14 responses (not including us), only 2 use TSWs to assist, one of whom has used an external training course, another has managed it in house.
It looks as though, where nurses / ODPs are used to assist, pretty much all of them have undergone formal training.  I see that there was a related thread on this a couple of years ago, when some pointed out how hard it was to get nurses to assist when required unless formally trained.
The background with us is that we have, for very many years, had a number of TSWs who had undergone internal competency-based training and who have been assisting in lieu of the junior docs that we don’t have – presumably like the Charnley leg-holders of old.  I wasn’t actually aware of their banding or how they had been trained, but everyone seemed happy; they are a nice bunch, they assist very well and I have not even been close to having a concern about their competence or their ability to maintain sterility (which would be my main worry).  Unfortunately some staff who have undergone such formal training have said that they don’t think that this is reasonable, kicking off a Trust review.
Even though our set-up is perhaps a historical relic, it is helpful to know from this small sample that it looks as though we are probably unusual in what we do and so no doubt will have to go down the route of external courses etc etc (while also having to save lots of cash……!). 
Thanks again!

Best wishes

Hi no experience with PAS but great support from the surgical care practitioners who are in clinics, theatre, go to the ward each day and are willing to be flexible in order to support the team. They are particularly good at filling in gaps in theatre when there is no registrar after nights on call and enabling training of registrars by assisting so that the consultant can back off a bit. They contribute to audits, patient education groups, patient info leaflets etc and some of them can prescribe. Not sure about them covering the wards for sick patients that's when a doctor is needed I think but they can support the juniors in the routine checks of patients on the ward.

Sent with Good (
Sue Deakin
Clinical director surgery and consultant orthopaedic surgeon
West Suffolk Hospital

-----Original Message-----
From: Tim Waters [orthodirectors] []
Sent: Tuesday, October 11, 2016 01:35 PM GMT Standard Time
Subject: Re: [orthodirectors] RE: Physicians Assistants/Associates

We've had a better experience with pa's but it's still early days for us.(6 months) . So far they are functioning well , essentially doing ward work and general patient care. There are no theatre or clinic expectations . It helps fill junior rota gaps and the experience has been positive so far. 

Sent from my iPhone

On 11 Oct 2016, at 12:10, Shetty Ajit [orthodirectors] <> wrote:

We tried Physician assistants about 4  years ago at Mid-Yorkshire  Hospitals  ( 3  of them were appointed)  and had to quickly abandon !
Essentially they were meant to do some of the work junior doctors  did  so that the juniors could be freed for training but the Physician assistants expectations were completely different. They expected to be treated  as  doctors  &  wanted to be in clinics & theatres  which defeated  the purpose of appointing them.
There are not many of them around and they will call the shots.
We have now  replaced them with advanced  nurse practitioners (ANP’s) & they are working brilliantly.
Personal opinion – ANP’s & Advanced scrub practitioners are far better than Physician assistants.
Ajit Shetty