Doctors raise safety concerns over use of nurses in medical roles

Patients are being harmed because advanced practitioners are being used to fill roles traditionally performed by doctors, the British Medical Association has warned.

A dossier compiled by the doctors’ union highlights cases in which failures involving advanced practitioners—most of whom are experienced nurses—were followed by serious harm or death. The BMA said the incidents demonstrated the risks of placing staff in medical roles without equivalent training, supervision or regulatory safeguards.

Among the cases cited was the death of David Almond, whose risk of a pulmonary embolism was not recognised when he was seen by an advanced nurse practitioner at his GP surgery. He died from a major blood clot four months later.

The BMA has also pointed to an investigation at Rotherham General Hospital, where a consultant nurse performed complex endoscopy procedures after specialist doctors left the service. An independent review found that at least 68 patients suffered serious harm or died following substandard care.

Advanced practitioners can assess, diagnose and treat patients after completing additional training, usually at master’s level. NHS England says they are valued members of multidisciplinary teams but should not be used as direct replacements for doctors or work beyond their competence.

The Royal College of Nursing has rejected suggestions that advanced nursing practice is inherently unsafe, describing these clinicians as highly skilled autonomous professionals. It said individual incidents should not be used to undermine an entire profession and stressed the importance of appropriate governance and teamwork.

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