GESA has reiterated its opposition to independent nurse endoscopy services, saying they are ‘misguided’, unnecessary and will divert scarce nursing staff away from other vital roles in gastroenterology.
The Association previously expressed strong objections to nurse endoscopy services when programs were launched in jurisdictions such as Queensland in 2015. At the time GESA said there was no shortage of medically trained endoscopists in Australia and colonoscopies should only be performed, or at least supervised, by certified gastroenterologists and surgeons.
In a revised position statement, GESA reaffirms that view, noting that the Australian Commission on Safety and Quality in Health Care (ACSQHC) Colonoscopy Clinical Care Standard (2020) states that “colonoscopy should be performed by a credentialed clinician working within their scope of clinical practice, who meet the requirements of an accepted certification and recertification process.”
“There are sufficient specialist gastroenterologists and surgeons, and colonoscopists-in-training, to meet current and future demand in metropolitan and regional centres,” the statement says.
Any shortcomings in Australia’s endoscopic services are due to “inadequate infrastructure and underfunding, not lack of endoscopists”, it claims, adding that the pursuit of “non-physician endoscopic services for workforce and economic reasons is misguided”.
The revised statement says that training of new colonoscopists requires access to colonoscopy lists under the supervision of experienced medical and surgical colonoscopists. It also warns that the training and expansion of a nurse endoscopy workforce will place further pressures on the already unmet needs for specialised gastroenterology and hepatology nurses.
“A highly trained nursing workforce is essential to the provision of high-quality endoscopic services, as well as to support the care of patients with advanced liver disease, liver cancer and viral hepatitis, inflammatory bowel disease and intestinal failure. A dedicated nursing workforce is also essential to clinical trials management and to support the administrative requirements of endoscopy and clinic waiting lists and surveillance programmes,” it says.
It acknowledges that nurse-provided endoscopic services match the outcomes of those provided by medical proceduralists but says they are no more cost-effective.
“On the contrary, they may lead to the requirement for additional follow-up care from medical specialists including an increased rate of second procedures which impact finite resources and patient care delivery.”
GESA’s position is that high quality colonoscopy services are best provide by a medical procedural model supported by a skilled endoscopy nursing workforce. Nurse endoscopy should therefore be provided in parallel with, and under the supervision of, medical or surgical endoscopy services and should not be an independent service.
Therefore, nurse-endoscopy services will not be suitable to resolve the inadequate provision of services in Australian regional centres, the statement concludes.