TP8.2.28 Can surgical advanced care practitioners provide a cost effective local anaesthetic minor procedures service? Results from a 5-year retrospective study

Abstract

Aims Surgical Advanced Clinical Practitioners (SACP) form part of the extended surgical workforce and are drawn from allied health care backgrounds. The primary aim of this study was to determine if there is a financial benefit performing minor surgical procedures on dedicated SACP lists compared to consultant surgeon lists. Methods This was a retrospective cohort study including all patients who had a minor ‘lumps and bumps’ procedure undertaken between April 2014 and August 2019 at Anonymous Hospitals NHS Trust (AHT) under local anaesthetic by the general surgery team. Data such as lesion type, theatre staffing levels and operating time was collected. The cost of the procedure was calculated by operating time multiplied by cost of staff of per minute according to local banding. Results A total of 1399 patients had a lesion excised; the majority were carried out by a doctor n = 907, the rest independently by a SACP. The majority of lesions excised were lipomas and cysts. There was no difference in the median surgical time (20 minutes, IQR 14) taken to operate on each patient by SACPs and doctors. Minor procedures carried out on consultant surgeon lists cost 62.4% (£21.72) more on average than those on SACP lists (£56.55 vs £34.83 median respectively, p < 0.001) due to excess staff for these cases. Conclusion A dedicated and independent SACP ‘lumps and bumps’ list has shown to be a financially beneficial service. Operative times are similar to doctors. These lists free staff for consultant lists, potentially permitting more major cases.