The case for nurses who wield knife

It is one of the oldest games in the book, the "doctor/nurse" game, played out in surgeries and operating theatres across the country every day, and essential to the smooth-running of the health service.

The game - actually a recognised theory of nursing first described in the Sixties - revolves around a nurse making a decision about a patient, taking action and then, with the collusion of the doctor, "pretending" that the doctor did it all to appease hospital authorities, the law and the public.

Now it appears the game has moved on, with the case of a 47-year-old nurse, Gillian Erickson, who has carried out more than 200 unsupervised operations. She has the blessing of the Wirral Hospitals Trust, the surgeons at Clatterbridge hospital where she works, and the agreement of each patient. Collusion, it seems, is no longer necessary.

The "nurse-surgeon" revelation has generated the predictable knee-jerk reaction from some quarters. One senior consultant claims that people are now being treated "worse than animals which can be operated on only by a qualified vet".

That this is a minority view was reinforced by the whole-hearted backing of doctors' leaders yesterday, who agreed with Mrs Erickson's assertion that an experienced nurse is more competent than a junior doctor in training.

Dr Mac Armstrong, Secretary of the British Medical Association, said: "This is entirely consistent with what we believe is development of the relationship between the professions."

Dr Armstrong said that the consultant had the ultimate responsibility for a patient from diagnosis to discharge. A doctor would not delegate to anyone that he or she thought was incompetent.

Dr Vivienne Nathanson, head of Professional Services at the BMA, said: "Doctors are not about individual treatment or tests, but the overall view and management of the patient and their condition."

Mrs Erickson, who has more than 20 years' experience as a theatre nurse, is unusual in that she initiated her new role at Clatterbridge. She put forward a business proposal in which she carried out certain surgical techniques unsupervised - including biopsies, and the removal of cysts. The proposal was accepted and consultants now refer some patients to Mrs Erickson for her own surgical list.

Previous schemes, in which nurses assist surgeons, tend to have been promoted by doctors who have observed practice in American hospitals. Suzanne Holmes, a nurse at the John Radcliffe hospital in Oxford, was one of the first. She worked alongside a heart surgeon stripping out veins for bypass operations, as is routine in America.

Despite this - and the publicity the scheme attracted in 1992 - there was still an outcry when it emerged in 1994, Valerie Tomlinson, a nurse at the Treliske Hospital in Truro, had removed a patient's appendix, albeit supervised by a surgeon. The surgeon was cautioned and the nurse took early retirement.

Gillian Erickson looks set to change all that, and with the increasing demand for health care services, and the continuing crisis in medical staffing, she will be the first of many.