Over the last decade, nurse-led services have been introduced as an alternative pathway of patient care, in part to undertake work performed by trainee medical staff before the reduction in working hours. In response to the loss of trainee hours resulting from implementation of the European Working Time Directive, we set up a new service with a highly experienced gynaecology nurse who underwent additional training in preoperative assessment and consenting. The service was founded on the nurse-practitioner's expertise, together with the use of an integrated care pathway and 12 preformatted consent sheets. We undertook a case note review of 100 consecutive patients. The review of the service showed a high level of compliance for performance of laboratory and radiological investigations, both in terms of completion and the avoidance of unnecessary tests. In addition, the nurse-practitioner was able to obtain written consent from almost 87% of women undergoing surgery using a range of just nine preformatted sheets. No serious medical issues were overlooked and no operations were cancelled on the day of surgery. The quality of documentation was exemplary and there were no complaints or clinical incidents related to the nurse-practitioner in 4 years of service. The quality of patient care can be maintained, if not improved, by integrating nurse-led preoperative assessment into the departmental clinical pathway for women choosing elective surgery.

A recent publication of an evidence-based clinical guideline for male and female sterilisation by the Royal College of Obstetrics and Gynaecology (RCOG) created a stimulus for a review of our female sterilisation service. We arranged for a gynaecology nurse-practitioner (A.O.) with extensive experience in general gynaecology and contraception to undergo additional training in counselling female sterilisation. She then took over the daily running of the sterilisation clinic using a care pathway and pre-printed letters. She had open access to a consultant (R.F.) for advice. A review of 100 consecutive referrals showed that the nurse followed the guidelines extremely closely both in terms of referral to the medical team for advice and/or further counselling and quality of documentation. A total of 59% of the women attending the clinic were cared for by the nurse-practitioner alone. Only four had to see a consultant. All women questioned expressed very positive comments about the style and content of counselling and just one stated she preferred to see a doctor.