BMA ‘wrong’ to suggest ANPs pose a risk to patient safety, says chief nurse

Nursing leaders have hit back at the British Medical Association (BMA) over its suggestion that advanced practitioner roles – including nurses – pose a risk to patient safety.

In recent months the BMA has been raising concerns around ‘doctor substitution’ and has been seeking views from its members on what it says is ‘unhelpful and inappropriate blurring of the distinction between doctors and non-medically qualified staff’.

Results from its survey of 5,000 doctors have this month seen 71% report that advanced practitioners are occasionally or frequently ‘doing work only doctors should do’ and 81% said the way advanced practitioners currently work ‘is a risk to patient safety’.

But the Royal College of Nursing (RCN) and England’s chief nursing officer (CNO) have this week strongly criticised the union’s claims and stressed that nurses working at an advanced level are ‘highly-skilled experts in their own right and not replacements for doctors’.

CNO Duncan Burton said: ‘It’s disappointing that despite the BMA’s stance on the need for multidisciplinary teams, they are at risk of undermining the work of advanced practitioners, who are regulated professionals – including nurses – that have extensive clinical experience, are educated to masters level, and working hard alongside doctors.’

He added: ‘Advanced practitioners will never replace doctors – and it is wrong to suggest these roles pose a risk to patient safety – patient safety is non‑negotiable, and I want to be clear that advanced practitioners enhance the quality of patient care.’

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Meanwhile, RCN chief nursing officer, Professor Lynn Woolsey said: ‘Nurses working at an advanced level are highly-skilled experts in their own right and not replacements for doctors.’

She explained that they range from district nurses ‘keeping patients with complex needs safe at home’ to a cancer specialist nurse ‘running essential clinics and helping people manage their symptoms’. to the advanced district nurse keeping patients with complex

‘Wherever they are in the NHS, they are assessing, planning and coordinating the delivery of care as specialists in their fields. Without them, the health service would grind to a halt,’ said Professor Woolsey.

She added: ‘Patient safety is non-negotiable for both doctors and nurses and the focus must be on clinical governance, underpinned by commitments to ensure any incidents are properly reviewed.

‘Concerns about doctor shortages will be better solved by improved workforce planning to ensure all services are staffed with the right number and mix of clinical professionals.’

The RCN accused the BMA of ‘eroding professional cooperation and public trust’ and said this was ‘a major risk to patient safety and care quality’.

‘It is misleading of the BMA to make claims of “substitution” without providing the clinical context, such as where patient need determines rotas are nurse-led or shared between professions,’ added Professor Woolsey.

In releasing its survey results, the BMA called on the government to review the scope of practice of advanced practitioners, ‘with the adoption of national standards that protect patients and prevent the blurring of doctor and non-doctor roles’.

Dr Tom Dolphin, chair of BMA council, said: ‘We have here clear testimony that non-doctors are being asked to take on an alarming level of responsibility for medical tasks for which they are not qualified, on a hitherto unprecedented scale.

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‘The NHS runs on multiprofessional teams, but the boundaries between those professions have been eroding, whether due to cost-saving measures, understaffed hospitals or just negligent management.

‘The simple fact is that some tasks should only be done by uniquely trained doctors.

‘Our profession could not be clearer: we believe the blurring of these lines is putting our patients at risk.’

He claimed that ‘thousands’ of advanced practitioners were ‘being let down by an NHS management that is failing to prioritise patient safety’.

‘These are our valued colleagues and we must not be putting them in a position where patient safety incidents occur simply because their hospital management could not fill a medical rota.

‘If we can work together to end the relentless shifting of medical tasks onto colleagues who don’t want them and should not have to deal with them, we can rebuild that multiprofessional approach where everyone can excel at what they do best.’

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Speaking at a Nursing in Practice event in London last month, RCN chief executive and general secretary Professor Nicola Ranger vowed to ensure that advanced practice nursing is not ‘undervalued and diminished’.

She expressed her disappointment in what she described as an ‘attack’ by the BMA on nurses.

In March, the Nursing and Midwifery Council (NMC) also stressed that advanced nurse practitioners are ‘not a substitute for medical practitioners’ but a ‘welcome and vital role’.