Concerns have been raised about the use of advanced practitioners on doctors' rotas amid patient safety warnings.
The British Medical Association (BMA) has written to NHS trusts across England, including the Royal Berkshire NHS Foundation Trust, calling for urgent action after Freedom of Information data revealed that nearly half of NHS employers are placing less qualified staff on doctors’ rotas.
The BMA has warned that while advanced practitioners from nursing, paramedic, or pharmacy backgrounds are valued members of healthcare teams, allocating them to doctors' shifts could push them to operate beyond their training and expertise.
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Dr Tom Dolphin, BMA council chair, said: "Advanced practitioners are highly valued members of the healthcare team, but they are not a substitute for doctors.
"Asking them to fill gaps on medical rotas risks pushing them beyond their training and creates real concerns about patient safety.
“We are seeing worrying variation between trusts. In some areas, patients can be confident they will be treated by a doctor when that is what is needed, while in others they may be seen by a less qualified member of staff when the unique training of a doctor is required. That kind of unsafe care is not acceptable and must end immediately."
Dr Dolphin went on to say it was also unfair on advanced practitioners themselves, who may be placed in roles they are not trained for and potentially putting their professional registration at risk.
The Royal Berkshire NHS Foundation Trust has issued a statement, stressing that advanced practitioners are not being used as replacements for doctors.
A trust spokesperson said: "Patient safety is our top priority. Advanced practitioners are highly skilled and valued part of our multidisciplinary teams, they bring a wealth of skills and experience from pharmacy, nursing, paramedic, and other professional backgrounds that play a key role in supporting us to provide compassionate care to our patients.
"They are not replacements for resident doctors. We follow national guidance and regularly review how our teams are set-up to make sure patients receive safe and high quality care by the right professional."
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The BMA has raised concerns that in some areas this practice is being driven by staffing pressures rather than safe workforce planning.
Dr Dolphin went on to say : "Both NHS England and the Nursing and Midwifery Council are clear that advanced practitioners should not be used to replace doctors, and the Royal College of Physicians has warned this approach risks fragmented care and harm to patients."
The BMA is urging all trusts to review their staffing policies and ensure that only appropriately trained professionals are fulfilling doctors’ duties.
Dr Dolphin said: "We are calling on trusts to urgently review their policies, ensure staff are working within their competencies, and set out what action they will take to prevent the inappropriate substitution of doctors.
"Patients deserve clarity about who is treating them and the assurance that care is being delivered by the appropriately trained professional."
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