Almost half of hospital trusts have been asking non-doctors to fill in on medical rotas, according to FoI (Freedom of Information) requests lodged by the BMA.
The association had responses from 85 of 202 trusts in the UK, with 41 (48 per cent) confirming they permit AP (advanced practitioners) to cover doctors’ rota gaps.
APs are healthcare professionals with backgrounds including nursing, paramedic, physiotherapy and pharmacy. While many are experienced in their base profession, working on medical roles is beyond their scope of practice.
The BMA has said using APs to fill doctor rotas is a risk to patient safety and that the FoI data showed a ‘slapdash’ approach by NHS trusts and a postcode lottery for patients.
BMA council chair Tom Dolphin said the findings were evidence of a ‘haphazard’ approach to staffing from NHS management at the trusts in question.
Blurred lines
Dr Dolphin 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 training and expertise is required.
‘What is especially concerning is just how slapdash the NHS’s approach is. Many trusts have clearly and sensibly told us they would not put a non-doctor into the role of a doctor. Other trusts have unashamedly responded that they have done. 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 good 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 and uniform scopes of practice to stop this blurring of professional lines are needed, so no patient comes to harm.’
DOLPHIN: 'Potential disaster for everyone involved'
NHS England describes APs as ‘accomplished registered health and care professionals’ working at ‘a level of practice characterised by a high degree of autonomy and designated responsibility for complex decision making’, underpinned by master’s level qualifications.
The role was designed to offer expertise in a specific field – but strictly within the scope of the AP’s base profession.
The Nursing and Midwifery Council confirmed last month that ‘advanced practitioners are not a substitute for medical practitioners’ after the BMA called for doctors to provide the association with examples they have seen of APs working beyond their scopes.
It follows other work the BMA has done to prevent doctor substitution, including by PAs (physician assistants) and physician assistants in anaesthesia.
The Leng Review into these roles recommended that PAs ‘should not see undifferentiated patients except within clearly defined national clinical protocols’.
Legislation going through Parliament is expected to confirm this but does not cover APs.