The BMA has today raised the alarm as freedom of information (FOI) requests of UK hospital Trusts and Boards reveal how many are putting less-qualified staff on doctors’ rotas in place of a doctor. Almost half the employers who responded said “yes” when asked if they permitted Advanced Practitioners - NHS clinicians who are not trained as doctors - to cover doctors’ rota gaps (41 Yes to 44 No).
When deployed correctly, Advanced Practitioners (APs), who include healthcare professionals with nursing, paramedic, and pharmacist backgrounds, play an important role in looking after patients in the NHS. However, in an attempt to plug persistent staffing gaps, employers continue to use them beyond their level of training, moving them away from their areas of proficiency and into roles only doctors are qualified for.
Dr Tom Dolphin, chair of BMA council, said:
“Our colleagues in advanced practice roles are valued members of our multidisciplinary teams. Yet our research reveals an NHS management that will risk patient safety to push these professionals out of what they do best and use them as spare capacity to fill up understaffed doctors’ rotas. While other healthcare roles can be enhanced within safe limits, this must never encroach into areas where a doctor’s specific training and expertise is required.
“What is especially concerning is just how slapdash the NHS’s approach is. Many employers have clearly and sensibly told us they would not put a non-doctor into the role of a doctor. Others have unashamedly responded that they have done exactly that. That these responses split almost down the middle is an indictment of an approach by Trusts and the NHS which means that where you live determines whether you will be seen by a doctor or by someone else for the same condition.
“This is a potential disaster for everyone involved. Advanced practitioners are being asked to do jobs they shouldn’t have to. Patients are being given no clarity about who is treating them and what level of care they’re meant to be getting. Doctors are being left unclear on where the lines are drawn. The whole thing is a haphazard mess brought on by an absence of workforce planning and rational thinking about who can do what.
“Patients deserve a consistent standard of care whichever hospital they happen to live near.
They shouldn’t have to worry about whether the local managers have asked non-doctors to deliver care that only uniquely-qualified doctors can safely deliver.
“An NHS stretched to breaking point is no excuse. Better regulation and clear, uniform scopes of practice to stop this blurring of professional lines are needed, so no patient comes to harm.”
Notes to editors
Responses to our FoI requests included:
Please confirm whether in your Trust/Board advanced practitioners ever make referrals to other specialties
Yes – 82
No – 6
Unclear / N/A – 16
Whether APs are ever permitted to hold crash / emergency bleeps
Yes – 55
No – 32
Unclear / N/A – 17
If advanced practitioners are ever deployed on medical rotas
Yes – 43
No – 45
Unclear / N/A – 16
If advanced practitioners are permitted to cover doctor rota gaps
Yes – 41
No – 44
Unclear / N/A – 17
Examples of responses from NHS Trusts and Boards when if asked advanced practitioners are ever deployed on medical rotas:
Birmingham Women’s:
“Yes - Advanced practitioners are trained and employed to work in the same role as their medical colleagues. This means they do work on medical rotas which can be SHO or registrar depending on the speciality and level of training... Some APs that are employed to do non-acute roles work on their own rotas but still perform in a medical role.”
Dumfries & Galloway:
“In critical care, ACCPs cover middle-grade roles as part of tiered rotas. In out of hours APs work (as) GPs.”
The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.