Advanced clinical practitioners have hit back at the British Medical Association’s (BMA) warning that the increasing use of non-doctors in medical roles is unsafe, describing the characterisation as unfair and arguing that the real issue is poor governance.
In a letter responding to recent media coverage, an advanced clinical practitioner in acute respiratory medicine said they assess and manage patients with severe conditions such as COPD exacerbations and pulmonary embolisms, working in a consultant-led team. They stressed that advanced practice is a distinct, evidence-based role that enhances care, not a substitution for doctors. They noted that the cases cited in the article, at Rotherham General Hospital and a GP practice, were failures of organisational governance, not evidence of inherent unsafety.
Another letter writer, Helena Scott from Dumfries, highlighted a Cochrane systematic review that examined 82 randomised studies involving over 28,000 patients across 20 countries. The review found little to no difference between nurse-led and doctor-led care on critical outcomes, including mortality and patient safety events, with nurses performing marginally better on some measures. Scott argued that the BMA, as a trade union for doctors, has a conflict of interest in limiting the expansion of advanced practitioner roles, and that missed diagnoses by doctors are often less visible.
Lynn Malloy from Crouch End, London, shared positive personal experiences of advanced nurse practitioners in stroke services, and noted that many doctors acknowledge the key role of other professionals in developing their clinical skills. She argued that the NHS functions best through cooperative teamwork, something the BMA seems hesitant to acknowledge.
