Safety Fears As Half Of UK Hospitals Use Non-Doctors As Doctors

It has been revealed that nearly half of all NHS hospital trusts are using “non-doctors” to fill in the roles of doctors.

Under qualified staff are being used to fill in “rota gaps”, in a move that the doctors union have described as a “potential disaster”

Health professionals known as advanced practitioners, mainly senior nurses, are undertaking roles usually performed by doctors in A&E, neonatal units, critical care and other areas.

The Guardian reports: Almost half of hospitals in the UK are deploying APs to cover gaps in doctors’ rotas, according to figures obtained by the British Medical Association under freedom of information laws from NHS trusts in England and health boards in Scotland, Wales and Northern Ireland.

The BMA warned that the widespread use of “non-doctors” in medical roles is “simply not safe” and may be driven by hospitals using staff who are cheaper than doctors to save money.

Its revelations follow a number of cases in which mistakes in either diagnosis or treatment by APs led to patients being harmed or dying.

“Doctor substitution” appears to be in breach of NHS guidelines in England. NHS England said that while advanced practitioners have very valuable skills, in order to ensure patient safety, such staff “should not replace the roles of doctors”.

Despite that rule, some NHS trusts made clear in their responses to the BMA that they do use experienced non-medical staff with specialist skills in roles that doctors would usually perform.

For example, Birmingham Women’s and Children’s NHS trust said: “Advanced practitioners are trained and employed to work in the same role as their medical colleagues.

“This means that they do work on medical rotas, which can be SHO [senior house officer] or registrar [level] depending on the specialty and level of training.”

Barking, Havering and Redbridge NHS trust in east London – where many of health secretary Wes Streeting’s constituents get their care – said that in its two acute hospitals advanced practitioners’ “coverage typically aligns to junior or middle grade [doctors’ roles]”.

In Scotland, Dumfries and Galloway health board includes APs alongside doctors on medical rotas in its critical care unit and also as part of its out-of-hours GP service. And Forth Valley health board uses them in its inpatient children’s and neonatal services.

In a further formalisation of APs’ role providing care usually done by doctors, 55 of the NHS bodies across the UK that responded to the BMA’s request for information said they allow APs to hold crash bleeps, so they can be called if an emergency arises, which traditionally only doctors have. Only 32 said they did not do that.

“The extent of doctor substitution shown by these figures is very concerning. It is startling to see close to half of NHS organisations reporting that they use APs in doctor staffing, holding the emergency bleeps and making referrals to different specialities,” said Dr Mel Ryan, a paediatric registrar in Nottingham and a BMA lead on preventing doctor substitution.

“There is a vast difference in the level of education and training between doctors and APs. APs cannot substitute for doctors, yet alarmingly many employers are doing just that.

“I think it is scandalous that the NHS is allowing the substitution of doctors by individuals without sufficient medical knowledge instead of the obvious response to doctor shortages: hiring more doctors,” she said.