Variation in Surgical Care Practitioner (SCP) roles, training and scope of practice across clinical settings, combined with a limited and heterogeneous evidence base, means we cannot draw definitive conclusions about their clinical effectiveness, safety or cost effectiveness in performing high-volume, low-complexity procedures in Scotland.
- The published literature indicates that SCPs performed selected procedures safely, leading to improvements in waiting times and patient satisfaction. The findings are specific to procedures within a particular setting and should not be assumed to apply across different specialties or contexts.
- A case study from NHS Forth Valley showed SCPs successfully carried out non-complex urology procedures including vasectomies and circumcisions. Vasectomy service data illustrated an improvement in patient throughput and a reduction in waiting times. These findings are specific to the NHS Forth Valley one-stop outpatient service model.
For SCPs to be scaled across NHSScotland, clear governance structures, standardised training pathways and ongoing evidence collection and evaluation mechanisms are essential to ensure safety, quality and consistency of care.
What were we asked to look at?
In April 2025, the NHS Executive Leadership Group approved the creation of a Workforce Diversification Sub-Group, operating under the Productivity and Efficiency Group. The sub-group was tasked with identifying workforce innovations that could be rapidly scaled across NHSScotland. As an initial focus, the group agreed to develop a value case for the national rollout of Surgical Care Practitioners (SCPs), which would start with small tests-of-change. To support this, we were asked to produce an SHTG Assessment which reviews the published literature on the clinical effectiveness, cost effectiveness, patient experience and safety of SCPs.
Why is this important?
SCPs have been part of the NHS workforce since the 1990s, though their deployment has been predominantly concentrated in England. In Scotland, their use remains limited. SCPs undergo specialised training that equips them to perform a range of tasks traditionally carried out by medically qualified staff. This includes undertaking low-complexity, high-volume surgical procedures which often have significant waiting lists, such as carpal tunnel release and vasectomies. SCPs can be involved anywhere on the patient pathway, from referral through to discharge. Expanding the role of SCPs within NHSScotland presents a number of potential benefits. These include reducing reliance on agency staff, improving service productivity, shortening waiting times for patients, enhancing patient satisfaction and freeing up resources for use elsewhere in the NHS.
