Case Study
Endoscopy Assistant Role
East Sussex Healthcare NHS Trust
Introduction
East Sussex Healthcare NHS Trust provides both acute and community NHS services for people in the East Sussex and surrounding area. Two district hospitals of Conquest Hospital, Hastings and Eastbourne District General Hospital offer 24 -hour services including Accident and Emergency and the comprehensive range of surgical, medical and maternity services supported by a full range of diagnostic and therapy services. Bexhill Hospital and Rye, Winchelsea and District Memorial Hospital support service delivery whilst community services are provided by community teams in clinics and the patient’s own home. 21,800 cancer referrals, 283,000 X-rays and scans and 7 million pathology tests are undertaken every year by the Trust.
What was the issue/problem that needed to be addressed?
Endoscopy has been a difficult area to recruit to within the Trust and is a busy service undertaking 14,500 endoscopy procedures in 2021 across the two units based in Eastbourne and Hastings. During the Covid pandemic in June 2020 the Trust lost 50% of its Endoscopy Nurses and at one point had to shut one of its treatment rooms due to a shortage of staff. This accelerated the implementation of the Endoscopy Assistant Role which was already in development to optimise skill mix. This was all in line with the Trust priority of ‘taking action on recruitment and retention’.
What action was taken to address the issue?
Traditionally the Endoscopist is supported with procedures by two registered Band 5 Endoscopy Nurses and the Trust wished to look at an alternative staffing solution. The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) accreditation standards for endoscopy services do not mandate that the Endoscopist has to be supported by only registered Band 5 Endoscopy Nurses during a diagnostic endoscopy procedure. So, the Trust developed the Endoscopy Assistant role which works alongside a registered Endoscopy Nurse supporting the Endoscopist and thus only requires one registered nurse; The Endoscopy Assistant is initially appointed at Band 3/ Annex U and Band 4 on completion of the role competencies.
Training:
The Trust developed a knowledge, skills and behaviours assessment-based framework based on the Skills for Health Level 4 Associate Nursing/Assistant Practitioner Core Competencies and the key JAG 13 endoscopy skills which the Endoscopy Assistant can be assessed against to ensure their capability and competence for the role.
The Trust developed two training routes to develop the new role based on the Competency Framework:
- The Competence Framework approach for existing experienced Endoscopy HCAs which is recognised within the Trust’s own Endoscopy Units, and they can be assessed against in the role ‘on the job’.
- A Foundation Degree Programme route for other existing Trust staff potentially without endoscopy experience. This is nationally recognised and delivered in partnership with University of Brighton. The post holder attends this course once a week over an 18-month period for the underpinning knowledge and also has to meet the Framework competencies to demonstrate the skills in the workplace when undertaking the role.
Two Endoscopy Assistants were appointed in June 2021- one to each route so the Trust will be able to evaluate both routes once existing role holders have completed training and are fully competent which is up to three years although it’s anticipated they will achieve the competencies within 12-18 months.
In implementing the role, the Endoscopy Assistant is supernumerary in the first six months when they can observe and learn the requirements of the role and commence assessment of their competence of skills.
They are assigned a mentor and also buddy up with a more experienced member of staff.
The Trust has adopted the ‘Associate Nurse Practitioner’ title for anyone who has undertaken the foundation degree. As the Endoscopy Band 4 role isn’t dependent upon the foundation degree, it was agreed to call the role ‘Endoscopy Assistant’.
The role: The Endoscopy Assistant assists the Endoscopist with managing the airway and taking biopsies and samples but cannot administer drugs. They are under the indirect supervision of the registered Endoscopy Nurse who is always in attendance during the procedure, and they work under the direction of the Ward Matron/Lead Nurse.
Endoscopy Assistants work autonomously within the clearly defined boundaries of their Associate Nursing Practitioner Competencies and carry out specific delegated clinical tasks and responsibilities that may cross professional demarcations of care working.
Once competent they can also work in a supervisory role, in regard to any Support Workers.
Funding the role: The 2 Endoscopy Assistants who are currently in post have been funded by Band 5 vacancy underspend.
What difficulties and barriers needed to be overcome to implement the change?
The biggest challenge was initially convincing the Trust’s ‘New Roles Group’ and the Education Department that an experienced Endoscopy Health Care Assistant does not need a foundation degree to undertake the role and can be developed and assessed against the Competency Framework. This was overcome and the posts recruited to.
What benefits have resulted from the change?
As the new Band 4 Endoscopy Assistant Role was developed to work alongside a registered Endoscopy Nurse supporting the Endoscopist and this now requires one and not two registered nurses this assists the Trust in staffing the Endoscopy Unit when B5 nurse recruitment is a challenge and is also more cost effective.
This in turn enables the Trust to meet the JAG and CQC requirements and the cancer wait times, supports the increasing demand for endoscopy procedures, assists with reducing waiting lists so improving patient care, as well as offering a career progression opportunity for Trust Band 3 Endoscopy and other Health Care Assistants.
‘’The Endoscopy Assistant role has been well received by other staff who recognise the value of the new role in both our Endoscopy Units and means we can now potentially offer a clear progression route from a Band 3 HCA to the 8a Endoscopy Nurse Consultant role. It’s not a race and the new role will be supported to ensure that the role holders are fully competent’’. Sue Winser, Service Lead for Endoscopy. susan.winser@nhs.net