Surgical First Assistant

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The role of a Surgical First Assistant

In NHS Scotland, the role of surgical first assistant (SFA) can be undertaken by either an experienced registered nurse or an operating department practitioner (ODP).    

Surgical first assistants are level 6 practitioners who: 

  • have expertise within speciality/ area of practice that demonstrates the required breadth of knowledge required to lead safely, effectively, and efficiently  
  • can demonstrate initiative and are creative in finding solutions to problems   
  • have some responsibility for team performance and service development, and they consistently undertake self-development  
  • are registered on the nurses' part of the Nursing and Midwifery Council (NMC) register or the Operating Department Practitioner register with the Health and Care Professions Council    
  • have successful completed a nationally recognised programme of study, such as a university accredited programme or an in-house training package   

SFAs provide surgical assistance to the operating surgeon during an operation. Their role is primarily intra-operative work, although pre and post-operative visits may also be part of the role. The surgical first assistant works under the direct supervision of the surgeon who remains in theatre until surgery is completed.  

The tasks and activities performed by the SFA include:  

Surgical First Assistant
  • enhancing communication between the perioperative team, ward and patient  
  • completion of the WHO surgical safety checklist  
  • assisting with patient positioning on the operating table  
  • assisting with skin preparation and draping  
  • skin and deep tissue retraction  
  • handling body tissues / organs  
  • laparoscopic camera and instrument manipulation  
  • cutting ties and sutures  
  • simple wound dressings   


Following completion of accredited extended skills training, SFAs can go on to carry out extended skills that is: applying direct diathermy, infiltrating wounds with local anaesthetic, suturing wound drains in place and carrying out skin closure with sutures, staples or wound adhesives.  

SFAs are responsible to the theatre management team and clinically responsible to the operating surgeon who delegates aspects of their role.   

They are accountable to the professional body with whom they originally registered, either the Nursing and Midwifery Council, or Health and Care Professions Council.  

Career pathway

Those who want to consider a role as SFA, should first be an adult nurse registered with the NMC or Operating Department Practitioner (ODP) registered with the Health and Care Professions Council.  

Registered nurses and ODPs, preparing for the role of SFA in NHS Scotland should complete a nationally recognised programme of study, such as a university accredited programme, an in-house training package supported by the AfPP competency toolkit, or the new NHS Scotland Academy accelerated Surgical First assistant Programme.  

Ongoing career development can happen in different ways. SFAs may choose to develop or remain at the same level building on existing experience, knowledge and skills. They may choose to engage in additional training to extend the skills they can perform within the SFA role.  

SFAs may also choose to advance to higher levels of responsibility, knowledge and skills and progress through the career levels within the Perioperative Career Development Framework, for example, progressing to be a surgical care practitioner.   

Career Case Studies

These bitesize videos provide a useful insight into the role of the SFA within the perioperative team and would be especially useful for those considering this role in the future. They present a discussion between an orthopaedic surgeon and a surgical first assistant.

Mr Chris Gee is a Consultant Orthopaedic Surgeon at the Golden Jubilee National University Hospital,  where he is also Clinical Lead for Orthopaedics. Chris has a professional interest in robotic knee surgery. Fiona Green is a Surgical Care Practitioner in the Orthopaedic Team at the Golden Jubilee National University Hospital, and was previously Senior Educator with the NHS Scotland Academy, developing Scotland's first Surgical First Assistant Programme. Fiona works with Chris and his Consultant colleagues in theatre, providing surgical assistance, utilising the extended skills of a SCP.




Experienced Registered theatre nurses and ODPs in Scotland wishing to extend their practice, who have the support of their employing Board can apply for an accelerated workforce programme for surgical first assistants delivered by the NHS Scotland Academy. This programme provides additional learning in a range of areas, including immersive simulation and extended scope of practice skills for the surgical first assistant role.

Through high quality training and education, learners will complete the programme ready to join the non-medical surgical workforce and deliver safe and patient-centred care.