Health Service Circular (HSC, 199)

In 1999, the Health Service Circular (HSC, 199) specified that irrespective of the field of practice, the nurse, midwife or health visitor consultant role must be centered around certain interrelated functions, including: expert practice, professional leadership and research and evaluation (Cox, 2000). It recommended a consultant post be based in practice at least 50 percent of its time and this should involve working directly with patients, clients or communities. The consultant is also expected to exercise a high degree of professional autonomy and make critical clinical decisions if precedents and protocols do not already exist. The competencies required of a nurse, midwife or health visitor consultant have been set by the United Kingdom Central Council (UKCC), but the criteria for appointment depend primarily on the employer's expectations of the consultant post.

In the United states, an advanced nurse practitioner (ANP), the equivalent of the British nurse consultant, is expected to have diagnostic and prescriptive skills (Cox, 2000). If this is to be required in Britain, then necessary educational standards will have to be set. In the United States and Canada, the standard is set at the masters degree level. In England, the qualifications and standards are not yet defined, and there are a number of labels given to advanced practice roles, such as nurse practitioner, clinical nurse specialist, clinical nurse consultant or nurse clinician. The roles in these pos

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according to protocol -in the provision of emotional support, counselling, referral and discharge (Cox, 2000). Graduates of the ANP course are prepared to provide comprehensive healthcare, primary care and consultancy in various settings (Cox, 2000). They are able to work with doctors and other health care professionals in collaborative relationships beyond those of the regular nurse, and are in a position to influence the care provided by all members of the health care team. An examples of an ANP role is that of ANPs undertaking case management of patients presenting with musculoskeletal bleeding at the Haemophilic Care unit of the Royal London Hospital, providing clinics, undertaking comprehensive history and physical assessment of patients, diagnosing and treating joint bleeds and making referrals when required. The ANP also treats severely affected adults and children in the Home Treatment programme, managing central venous catheters, portacaths and other implantable venous access devices. At the Royal Free Hospital and the Homerton Hospital, ANPs in Colonproctology are involved in all phases case management of patients having peri-anal surgery, and case management of those with colorectal cancer, irritable bowel diseas

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