Hundreds of doctors have warned that patient safety across the NHS is being put at risk by the inappropriate use of advanced practitioners, a BMA report reveals.

A report published today by the association has laid bare the extent to which employers are using AP (advanced practitioner) staff to undertake roles and beyond their clinical abilities and which should be solely the responsibility of doctors.

Based on the testimonies of several hundred doctors and medical students from across the UK, the report details numerous examples of APs treating undifferentiated patients with little or no supervision, making inappropriate diagnoses or prescriptions and overriding decisions made by medical professionals.

These accounts, which were submitted to the BMA via an online portal, which opened in January this year, confirm many of the concerns long held by the BMA about the way many employers choose to deploy AP staff.

One specialist, associate specialist and specialty doctor based in southwest of England told the BMA that, in their workplace, AP staff were ‘essentially doing the same job as doctors’ despite not possessing the same qualifications and expertise.

The doctor added that, when they tried to flag their fears about the risks to patient safety, their concerns were ‘outright dismissed’ by their trust’s management.

They said: ‘Where I work, APs are essentially doing the same job as doctors. Many APs are working at the level of senior registrars, and lead APs are working at what is described as consultant level. Management even appoints APs and lead APs as clinical supervisors for doctors, including SAS doctors.

‘Patients often assume these APs are doctors. When concerns are raised, management dismisses them and insists that APs are properly trained and working at the level of senior doctors. In reality, APs are taking jobs that would normally be done by doctors. They cover doctors’ annual leave and sick leave and carry out almost all clinical duties expected of doctors. The only thing they do not do is write death certificates.’

They added: ‘In my view, doctors are still employed mainly so that responsibility and blame fall on them when something goes wrong. Overall, this is a very unsafe and distressing situation.’

Another doctor, a consultant based in the East Midlands, told the survey of how they had taken their daughter to hospital with suspected meningitis, only for her to be discharged incorrectly by an unsupervised AP, a decision which had serious consequences for her daughter’s health.

They said: ‘My daughter was seen by an AP in Paeds ED [emergency department]. I took her with concerns that she had meningitis. The AP discharged her with no bloods or referral. Daughter readmitted within 36 hours and diagnosed with meningitis. However, delay in diagnosis resulted in Lemierre’s syndrome, surgery and two CT heads. On that evening, the AP was the most senior clinician in paeds ED due to a rota gap for the paeds ED consultant.’

Responding to the survey findings, BMA council chair Tom Dolphin has called on NHS leaders to ‘wake up’ to the grim reality that substituting doctors for AP staff is undermining the role of the medical profession and presenting a ‘real threat to patient safety’.

He said: ‘These are shocking accounts of patients being let down by the system. We have made clear, over and over, that there are times when patients must be seen by a doctor and this testimony lays out why in extensive, excruciating detail.

‘Patients with missed diagnoses, patients with severe conditions given nothing but mild pain relief and sent on their way, and patients facing end-of-life conditions being offered totally substandard care: they all deserved so much better.

‘One patient was lucky their mother was a doctor, as otherwise a potentially fatal case of meningitis would have been missed. But you should not need to have a qualified doctor as a parent to get the right treatment in the NHS, and it is disturbing to think how many other similar cases might be out there.’

Although the BMA has repeatedly made clear that AP staff, as part of a multidisciplinary team, can play an important role in the delivery of healthcare, concerns with their inappropriate use in the health service have continued to mount in recent years.

A series of Freedom of Information requests by the BMA revealed in April this year that around half of all trusts and health boards admitted to using APs to fill rota gaps in place of doctors.

Meanwhile, a BMA survey of doctors published in May this year showed that 71 per cent said that APs at their workplaces ‘occasionally’ or ‘frequently’ undertook work that should be exclusive to doctors, with 81 per cent stating that the way APs work is a risk to patient safety.

In response to the concerns raised with the current use of AP staff, the BMA is calling an immediate ban on the use of non-doctors on doctors’ rotas, and an end to the ‘taskification’ of medicine, which see increasing numbers of duties are shifted to non-doctor staff.

The association is also demanding an urgent review of AP scopes of practice, with a view to implementing a national set of standards, and for the introduction of revalidation as a means of enhancing statutory regulation among AP staff.

Dr Dolphin said: ‘APs are not to blame for this systemic failure. They are NHS colleagues who are hardworking, talented individuals trying to make the best of a situation one doctor described as a “farce”: management pressuring non-doctors to plug gaps in doctor rotas and do things only doctors should be doing. This is not fair on them.

‘Again and again, we see accounts of hospitals in chaos where leadership has totally failed to draw appropriate boundaries around who should be doing what. When we requested information about this practice via the Freedom of Information process, every trust has admitted that it should not happen, for reasons that are very apparent reading this report.

‘Yet despite stating that they are against it, the reality is that this is a practice bizarrely condemned and condoned by the very same people. One trust, Arrowe Park, shockingly told us that this has become standard practice across the NHS.

‘These leaders appear to be either asleep at the wheel or actively supporting the unsafe substitution of doctors. We need NHS leadership to wake up. NHS England’s suggestion that hospitals should rely less on doctors, in order to cover for their lack of workforce planning, is a real threat to patient safety.’

Read the report