The BMA has today called for swift action from Government to protect patients as a new survey of doctors reveals widespread fears for patient safety over the chaotic way employers use advanced practitioners (APs) in the NHS. More than four fifths of doctors answered ‘sometimes’ or ‘frequently’ to the question do you believe the way that advanced practitioners currently work in the NHS is a risk to patient safety? 

Recently almost half of NHS trusts and boards in the UK admitted putting these professionals, including those with nursing, paramedic, and pharmacist backgrounds, on doctors’ rotas despite not being trained as doctors. This confusion of roles risks healthcare professionals working outside their area of competence and undertaking procedures and activities that only doctors should do, putting patients in danger. 

The new survey is the largest of its kind in the UK, answered by more than 5000 doctors. It confirms  the acute  concern of the profession over the substitution of AP roles for doctors: 

• 71% of doctors responding say that in their workplace APs are occasionally or frequently doing work only doctors should do 

• 81% say the way APs currently work is a risk to patient safety 

• 75% say they are occasionally or frequently concerned APs are working beyond their competence 

• 72% say APs occasionally or frequently make independent treatment decisions that should only be made by a doctor 

• 79% say APs occasionally or frequently are considered to be equivalent to doctors 

 

Dr Tom Dolphin, chair of BMA council, said:  

“This survey should be treated as an early warning light for everyone in UK healthcare.  If it was not enough that hospitals are admitting to putting non-doctors on doctors’ rotas, thousands of doctors are now telling us just how unsafe they think this is. There is no excuse for employers, the NHS or government to claim ignorance of the creeping practice of doctor substitution which will put patients at risk. 

“We have here clear testimony that non-doctors are being asked to take on an alarming level of responsibility for medical tasks for which they are not qualified, on a hitherto unprecedented scale. 

“The NHS runs on multiprofessional teams, but the boundaries between those professions have been eroding, whether due to cost-saving measures, understaffed hospitals or just negligent management. The simple fact is that some tasks should only be done by uniquely trained doctors. Our profession could not be clearer: we believe the blurring of these lines is putting our patients at risk. 

“Thousands of advanced practitioners up and down the country, whether nurses, physiotherapists, pharmacists or others, are being let down by an NHS management that is failing to prioritise patient safety. Three quarters of doctors are now worried these professionals are working outside their area of competence at the request of their employers.  

“These are our valued colleagues and we must not be putting them in a position where patient safety incidents occur simply because their hospital management could not fill a medical rota.  

“If we can work together to end the relentless shifting of medical tasks onto colleagues who don’t want them and should not have to deal with them, we can rebuild that multiprofessional approach where everyone can excel at what they do best. If we fail then the fears expressed in this survey have a terrible likelihood of being borne out in reality.” 

 

The BMA is calling for swift action from all four UK governments and their respective NHS leaderships. It has called for: 

• A review of AP scopes of practice, with the adoption of national standards that protect patients and prevent the blurring of doctor and non-doctor roles 

• The upcoming 10 Year Workforce Plan to urgently address the watering down of safe, professional medical care, with an end to the “taskification” of medicine – the shifting of more and more tasks to non-doctor professions 

• Improved statutory regulation of the advanced practice role, including through the introduction of revalidation 

• Preservation of the training pathways for doctors with the concept of ‘first right of refusal’ over any clinical training opportunity to ensure that the senior decision-makers of the future are adequately trained 

 

 

Notes to editors