Addressing growing concerns
The BMA supports multidisciplinary team working and recognises the crucial roles that different staff perform in the NHS. However, concerns have been raised across the medical profession about unhelpful and inappropriate blurring of the distinction between doctors and non-medically qualified staff.
We have heard of patient safety concerns resulting from non-medical clinicians being supported by their employers to work outside of their competency, or without sufficient supervision, or in ways that negatively impact the education and training of medical students and doctors.
When considering the safety of physician assistants and physician assistants (anaesthesia), we have also heard concerns about other clinicians being used as substitutes for doctors; particularly those working at the ‘advanced practice’ level. We want to learn more about the extent of these concerns to better understand the experiences of doctors working with non-medical clinicians, and of patients receiving care.
Next steps
We will use the information gathered to challenge any steps taken by government departments, NHS bodies, NHS employing organisations, and statutory education and training bodies, that diminish the role of doctors, or impact their education and training, through inappropriate utilisation and unsafe expansion of non-doctor roles.
Why this matters
The BMA’s view aligns with the World Medical Association’s Statement on Scope of Practice, Task Sharing and Task Shifting. If cohorts of non-medical clinicians are enabled and encouraged by their employers to perform tasks above their accepted level of competence (or within their competence but without supervision from a doctor where necessary), this risks decreasing the safety and quality of care.
It also risks delayed, incorrect or overdiagnosis, incorrect treatment and inability to deal with complications, fragmented and inefficient service and lack of proper follow up. It may also increase the overall cost of care, as non-doctor health personnel are more likely to rely on consultations, and diagnostic and other tests, to compensate for their lesser education and training compared to doctors.
How you can help
Survey on doctor substitution
To help inform our policy on doctor substitution, we are currently running a survey open to all doctors and medical students in the UK. It should take no more 10 minutes to complete and will remain open until 4pm on Thursday 12 February.
Doctor substitution reporting portal
We want to learn more about the impact of inappropriate doctor substitution, for example, where other clinicians have replaced or are replacing doctors on rotas, patient safety incidents, or where doctor or where there has been an impact on medical student education and training opportunities.
Please use our reporting portal to share your experiences without identifying any other healthcare professional or patient:
We may use submissions to inform and assist local engagement with employers by BMA staff and BMA local or regional representatives. We may also use or summarise your submission in media work, the BMA's own publications and/or lobbying on behalf of our members. Your personal information will be anonymised.
You will not routinely receive a response to a submission made through this portal. If you have a concern that requires a response, please make sure to raise it with a BMA advisor.
This form is not a substitute for the formal reporting mechanisms available to all doctors to raise patient safety concerns or to report missed educational or training opportunities. Further information on how to raise concerns can be found on our website.
About advanced practice
Advanced practice is a level of progression open to a wide range of non-medical clinicians in the multi-disciplinary team. The following publications provide a range of regulatory, professional body, and NHS guidance on frameworks, principles, and definitions used across the NHS:
- NMC principles for advanced practice
- RCN Professional Development Framework - Advanced Level Nursing
- NHS Employers - Advanced practice
- NHS England multi-professional framework for advanced clinical practice
- NHS Education for Scotland - Advanced nursing practice
- Professional framework for enhanced, advanced and consultant clinical practice in Wales
- Northern Ireland AHP advanced practice framework