The British Medical Association has compiled a dossier of more than 200 reports and cites five inquests that link failures by "advanced practitioners" to patient harm, including deaths. While shifting some primary tasks to pharmacists, nurses and physiotherapists can increase efficiency, changes must prioritise safety, clear roles and robust supervision. With NHS spending having doubled over 17 years without matching service improvements, the article argues for comprehensive reform rather than piecemeal fixes.
BMA Dossier: Replacing Doctors With 'Advanced Practitioners' Has Harmed Patients — Why the NHS Needs Radical Reform
Dominic Lipinski/PA Wire
Any serious effort to improve NHS efficiency is welcome, but changes must put patient safety first. A new dossier compiled by the British Medical Association (BMA) raises concerns that the substitution of doctors with lower-cost "advanced practitioners" has, in some cases, harmed patients and contributed to deaths. The debate highlights the trade-off between sensible task-shifting and the risks that arise when roles, oversight and training are unclear.
What the BMA Found
More than 200 reports were gathered by the BMA outlining incidents and concerns tied to care delivered by advanced practitioners — health professionals such as nurses and physiotherapists who receive additional training to take on extended clinical roles. In addition, five separate inquests concluded that failures involving advanced practitioners contributed to patient fatalities.
Task-Shifting: Benefits and Risks
Allowing pharmacists to treat minor ailments or enabling nurses to manage stable long-term conditions can free doctors to focus on work that requires their specialised training. When properly implemented, task-shifting can improve access and efficiency without compromising safety.
But the gains depend on robust safeguards: clear job definitions, consistent training standards, reliable supervision and transparent lines of accountability.
Systemic Problems Need Systemic Answers
Politicians often invoked the slogan "save the NHS" during the Covid pandemic, implying that preserving the institution is an end in itself. The NHS's purpose is to deliver competent, safe care. That should be the yardstick for any change to who provides that care. The dossier suggests that change has sometimes been driven by short-term cost-saving rather than patient safety.
Notably, the NHS annual budget has roughly doubled over the past 17 years without producing proportional improvements in frontline services. That underscores the need for fundamental, not piecemeal, reform.
Practical Reforms to Consider
- Standardise titles and public-facing explanations of clinical roles so patients know who is treating them.
- Set national training and accreditation standards for advanced practitioners.
- Ensure supervision, clinical governance and clear escalation pathways back to senior doctors.
- Improve incident reporting and independent review to identify when task-shifting creates risk.
- Align funding and workforce planning to prioritise patient outcomes rather than short-term savings.
The central principle must be simple: efficiency cannot come at the cost of safety. Britain needs root-and-branch reform of the health service that clarifies roles, strengthens oversight and ensures resources are used to deliver better care for patients.
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