I am an advanced clinical practitioner in acute respiratory medicine, and the British Medical Association’s (BMA) characterisation of practitioners like me as unsafe “substitute doctors” demands a response (Safety fears as UK hospitals use nurses to cover for doctors due to shortage of medics, 25 April).
Every shift, I 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, underpinned by a master’s-level qualification and over a decade of specialist experience. This is not doctor substitution. This is advanced practice: a distinct, evidence-based clinical role that enhances patient care rather than compromising it.
The cases cited in your 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.
There is a striking irony in the BMA raising patient safety concerns now. Sustained industrial action has resulted in hundreds of thousands of cancelled appointments and procedures, placing the NHS under extraordinary strain and placing greater demand on the very practitioners being dismissed as a safety risk. 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. It will be solved by a properly governed, collaborative workforce. Advanced practitioners are part of that and we deserve better than to be used as a political instrument.
Name and address supplied
Your report omits a critical conflict of interest: the British Medical Association is the trade union for doctors. It 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. It is a professional boundary dispute dressed as one.
The real question is not whether advanced practitioners are dangerous. It is 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.
Helena Scott
Dumfries
My experience of advanced nurse practitioners in stroke services has been exemplary. As a patient of other NHS services, I 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 being made. The NHS functions at its best through cooperative, respectful and complementary teamwork – something the BMA seems hesitant to fully acknowledge.
Lynn Malloy
Crouch End, London
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