Doctors have expressed serious concerns that patients are being endangered by treatment from advanced practitioners (APs) rather than fully qualified medical professionals, according to alarming new data from the British Medical Association (BMA).
Survey Reveals Widespread Concern
In a survey of over 5,000 doctors, four out of five respondents stated that the use of APs in the NHS compromises patient safety. Nearly a third (28%) indicated that APs' work 'always' impacts patient safety, while 56% said it 'sometimes' does. Furthermore, more than three-quarters of the doctors (3,874) agreed that the public often does not realize they are not being treated by a doctor, partly due to confusing job titles such as 'consultant clinical practitioner'.
Prevalence of Advanced Practitioners
Separate findings reveal that almost half of NHS hospitals are employing APs—typically nurses with additional training—to cover doctors' shifts. Approximately one in four trusts uses APs to cover for senior doctors. Across the UK, 48% of NHS trusts employ APs to fill junior doctor roles, and 23% use them for registrar positions, which are senior doctors just below consultant level. APs can also be pharmacists, paramedics, or physiotherapists.
Contradiction of Official Guidance
This practice directly contradicts NHS England advice, which states that APs 'should not replace the roles of doctors'. NHS guidance emphasizes that APs are 'not substitutes for more familiar professionals'. Despite this, a Freedom of Information (FOI) request from the BMA to NHS trusts revealed that 41 of 85 responding trusts admitted using APs to cover doctors' shifts, with 20 allowing them to stand in for highly experienced medics.
Case of Patient Harm
Last year, an AP working as a 'consultant nurse' at Rotherham NHS Foundation Trust left after an investigation found that 25 patients were harmed, seven fatally, following a complex endoscopy procedure they performed. The trust still allows 'senior advanced practitioners' to cover registrar shifts.
Trusts Defend Practices
Some trusts have integrated APs into medical rotas as standard. North Cumbria NHS Trust reported that APs could cover 'any grade with the exception of consultant' depending on competence. Lancashire Teaching Hospitals stated that APs in some departments could cover registrar roles if deemed to have consultant-level practice. Birmingham Women's and Children's NHS Trust said APs were on medical rotas as standard, trained and employed to work in the same role as medical colleagues because there was 'no difference in role'.
BMA Warning
Tom Dolphin, chairman of the BMA council, warned that APs are being placed in positions where patient safety could be compromised because hospital management 'could not fill a medical rota'. He described the findings as 'an early warning light for everyone in UK healthcare'.
Defence from Nursing Leaders
However, Lynn Woolsey, chief nursing officer of the Royal College of Nursing (RCN), defended the use of APs, stating that without them, the health service would 'grind to a halt'. She accused the BMA of attacking the sector through 'staged media interventions'.
A Department of Health and Social Care spokesman said APs are 'highly trained and play a central role in delivering care for patients, but are not replacements or substitutes for other roles'.
