ENGLAND — Almost half of hospitals in the United Kingdom are deploying advanced practitioners to cover gaps in doctors' rotas, according to figures obtained by the British Medical Association. The BMA warned that the use of non-doctors in medical roles may be driven by hospitals using staff who are cheaper than doctors to save money.

About half of all NHS organisations across the UK took part in the BMA survey. Of those, 43 said they deploy advanced practitioners on medical rotas, while 45 said they do not. A total of 41 said advanced practitioners are allowed to cover doctor rota gaps, and 44 said they do not permit it. Some 82 NHS bodies allow advanced practitioners to refer patients for tests and treatment, while six do not, and 55 allow them to hold crash bleeps so they can be called in an emergency, while 32 do not.

Advanced practitioners, who are mainly senior nurses, are undertaking roles usually performed by doctors in A&E, neonatal units, critical care and other areas. Birmingham Women's and Children's NHS trust said advanced practitioners work on the same medical rotas as their medical colleagues at SHO or registrar level depending on specialty and level of training. Barking, Havering and Redbridge NHS trust said their coverage typically aligns to junior or middle grade doctors' roles. Dumfries and Galloway health board includes advanced practitioners alongside doctors on medical rotas in its critical care unit and out-of-hours GP service, and Forth Valley health board uses them in its inpatient children's and neonatal services.

An inquest in Manchester in July 2024 concluded that David Almond died in January 2024 after an advanced nursing practitioner acting as a doctor at his GP practice did not realize that he was at risk of blood clots despite his history of the condition. When Almond was investigated for breathlessness in September 2023 at his GP surgery, he was seen by an advanced nursing practitioner rather than a doctor, coroner Alison Mutch found. Mutch said the possible risk of an embolism was not recognized and that an X-ray would not diagnose a pulmonary embolism. Almond died of a massive blood clot four months after the appointment.

A separate official inquiry found that a consultant nurse acting as an advanced practitioner at Rotherham general hospital performed a complex form of endoscopy combined with an X-ray between 2016 and 2021 because no consultant gastroenterologists were available. The inquiry found that at least 68 patients suffered serious harm or died as a result. The nurse was dismissed and the hospital apologised for substandard care that led to a cluster of adverse incidents and complications, including deaths.

An NHS England spokesperson said: "NHS guidance is clear – advanced practitioners are highly skilled practitioners and are valued members of NHS teams alongside doctors. These roles should not replace the role of doctors and should only be used in line with their competence and qualifications, and all staff are able to raise concerns where they are worried about patient and staff safety."