Letters respond to the British Medical Association’s (BMA) warning that the increasing use of ‘non-doctors’ in medical roles is unsafe. An advanced clinical practitioner in acute respiratory medicine challenges the BMA’s characterization, stating: “The claim of a safety gap is not supported by evidence.”
Advanced Practice Is Not Substitution
The practitioner, who works with patients suffering from severe chronic obstructive pulmonary disease exacerbations, pulmonary embolisms, pneumonia, and acute respiratory failure, emphasizes that their role is distinct and evidence-based. “This is not doctor substitution. This is advanced practice: a distinct, evidence-based clinical role that enhances patient care rather than compromising it,” they write. The practitioner holds a master’s-level qualification and over a decade of specialist experience, working within a consultant-led multidisciplinary team.
Failures of Governance, Not Practitioners
The cases cited in the original article—at Rotherham General Hospital and a GP practice—represent failures of organisational governance, not evidence that advanced practitioners are inherently unsafe. “Poorly supervised practice causes harm, regardless of whether the practitioner holds a medical degree,” the letter notes. The practitioner also points out the irony of the BMA raising safety concerns while industrial action has led to hundreds of thousands of cancelled appointments, placing greater demand on advanced practitioners.
Conflict of Interest
Another reader, Helena Scott from Dumfries, highlights the BMA’s conflict of interest as a trade union for doctors, with a direct financial and professional interest in limiting the expansion of advanced practitioner roles. She cites a Cochrane systematic review of 82 randomised studies involving over 28,000 patients across 20 countries, which found little to no difference between nurse-led and doctor-led care on critical outcomes. “On some measures, nurses performed marginally better,” she writes. Scott argues that missed diagnoses by doctors are endemic and largely invisible, while errors by advanced practitioners are amplified. “The real question is not whether advanced practitioners are dangerous. It is why clinicians of any background are being deployed in roles without adequate supervision and governance.”
Teamwork Over Hierarchy
Lynn Malloy from Crouch End, London, shares her positive experiences with advanced nurse practitioners in stroke services. She notes that the NHS functions best through cooperative, respectful, and complementary teamwork—something the BMA seems hesitant to fully acknowledge. “The more humble medical doctors acknowledge how key, particularly in their formative years, the role of staff from other professions has been in developing their clinical skills,” she writes.
These letters collectively argue that the BMA’s report reads more as professional boundary protection than genuine patient safety concern, and that the NHS workforce crisis will be solved by a properly governed, collaborative workforce, not by doctors alone.
