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The perioperative specialist practitioner: developing and evaluating a new surgical role
  1. R Kneebone,
  2. D Nestel,
  3. J Chrzanowska,
  4. A E Barnet,
  5. J Younger,
  6. A Burgess,
  7. A Darzi
  1. Department of Biosurgery and Surgical Technology, Imperial College London, London, UK
  1. Correspondence to:
 R Kneebone
 Department of Biosurgery and Surgical Technology, Division of Surgery, Oncology, Reproduction and Anaesthetics, Faculty of Medicine, Imperial College London, Chancellor’s Teaching Centre, 2nd Floor QEQM Wing, St Mary’s Hospital, Praed Street, London W2 1NY, UK; r.kneebone{at}


Introduction: This paper describes the design, implementation and evaluation of a new professional role in surgery. The role of the perioperative specialist practitioner (PSP), conceived as a response to the Working Time Directive, provides integrated preoperative and postoperative care to patients undergoing surgery in hospital.

Methods: A 1-year training programme was designed, dealing with a wide range of knowledge, skills and attitudes. Effective communication was a key component. Nine intensive 5-day modules at Imperial College London (London, UK) alternated with supervised experience of the surgical team at each participant’s home trust. Detailed evaluation of the role and the training programme was provided by an independent research team, using an interview-based qualitative approach. Observational data were provided by the project team. Data were analysed using standard qualitative methods.

Results: 27 PSPs across 12 National Health Service trusts took part in two PSP training programmes. A total of 124 interviews (94 individual and 30 group) were carried out with PSPs and their colleagues. Overall, the role was seen as successful and positive, with great potential for dealing with reductions in junior medical cover. Each site encountered different opportunities and problems. Lack of mentorship was a key issue, and the role provoked considerable opposition in trusts. The training programme was viewed as highly successful.

Discussion: PSPs can provide high levels of expertise, but within clear limits. Our training programme has been effective and is perceived to be of high quality. However, introducing a new role requires time and sensitivity if opposition is to be minimised.

  • CPG, core project group
  • PSP, perioperative specialist practitioner
  • WTD, Working Time Directive

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  • Funding: The pilot was funded by the Working Time Directive of the New Ways of Working Directorate of the Modernisation Agency.

  • Competing interests: None declared.

  • Ethical approval: Not required.

  • Contributors: AD and RK initiated the project. RK, DN and JY designed the training programme. RK, JY, AB and AEB implemented the project. JC conducted the evaluation interviews and analysed the data. RK wrote the paper and all authors helped to revise it. AD is guarantor.