The use of advanced practitioners in the NHS is no reason to fear for patient safety, according to readers responding to the British Medical Association’s warning that the increasing use of 'non-doctors' in medical roles is unsafe.
Advanced Practice: Evidence-Based and Safe
One reader, an advanced clinical practitioner in acute respiratory medicine, stated that the BMA’s characterisation of practitioners like them as unsafe 'substitute doctors' demands a response. They explained that every shift, they assess and manage patients with severe chronic obstructive pulmonary disease exacerbations, pulmonary embolisms, pneumonia, and acute respiratory failure, taking clinical responsibility in a consultant-led multidisciplinary team. This is underpinned by a master’s-level qualification and over a decade of specialist experience. They emphasised that this is not doctor substitution but advanced practice: a distinct, evidence-based clinical role that enhances patient care rather than compromising it.
The cases cited in the 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 reader noted the irony in the BMA raising patient safety concerns now, given that sustained industrial action has resulted in hundreds of thousands of cancelled appointments and procedures, placing the NHS under extraordinary strain and increasing demand on the very practitioners being dismissed as a safety risk. They argued that it is a curious position to simultaneously argue that fewer clinical staff should fill the gaps that the disruption creates.
The BMA is entitled to advocate for its members, but its report reads more as professional boundary protection than genuine patient safety concern. The NHS workforce crisis will not be solved by doctors alone but by a properly governed, collaborative workforce. Advanced practitioners are part of that and deserve better than to be used as a political instrument.
Conflict of Interest and Evidence
Another reader pointed out that the BMA, as the trade union for doctors, has a direct financial and professional interest in limiting the expansion of advanced practitioner roles. The claim of a safety gap is not supported by evidence. A Cochrane systematic review in February examined 82 randomised studies involving over 28,000 patients across 20 countries and found little to no difference between nurse-led and doctor-led care on critical outcomes, including mortality, patient safety events, and clinical outcomes. On some measures, nurses performed marginally better.
Meanwhile, missed diagnoses by doctors are endemic and largely invisible. They do not generate freedom of information requests, coroners’ prevention of future deaths reports directed at professional bodies, or media front pages. The same clinical failure carries a different narrative weight depending on who commits it. The amplification of advanced practitioner errors, while equivalent failures by doctors pass unremarked, is not a patient safety campaign but a professional boundary dispute dressed as one.
The real question is not whether advanced practitioners are dangerous but why clinicians of any background are being deployed in roles without adequate supervision and governance. That is a workforce and management failure. Attributing it to a professional group is a convenient distraction.
Exemplary Experiences
A third reader shared their experience with advanced nurse practitioners in stroke services, which has been exemplary. As a patient of other NHS services, they have received both excellent and neglectful treatment by senior medical staff. 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. Indeed, the most candid will acknowledge how, on occasion, these more experienced clinicians have stepped in to avert mistakes. The NHS functions at its best through cooperative, respectful, and complementary teamwork – something the BMA seems hesitant to fully acknowledge.
