The NHS doctor shortage sees advanced practitioners filling doctor roles across nearly half of UK hospitals, according to new data, raising concerns about patient safety and the growing reliance on non-doctor staff to cover critical medical duties.
Figures obtained by the British Medical Association through Freedom of Information requests show that advanced practitioners (APs), most of whom are highly trained senior nurses, are increasingly being deployed to fill gaps in doctors’ rotas in emergency departments, neonatal units, and critical care settings.
The findings have intensified debate over whether the NHS is stretching roles beyond safe limits as it struggles with a long-standing shortage of medical staff.
Widespread use of non-doctors in clinical roles
Data collected from NHS trusts and health boards across the UK indicate that almost half of responding organisations are using advanced practitioners in positions traditionally held by doctors. In many cases, APs are working on the same rotas as junior or middle-grade doctors, including roles equivalent to senior house officers or registrars.
Some hospitals confirmed that these practitioners are fully integrated into medical staffing structures. For instance, trusts reported that APs regularly participate in frontline care delivery, including diagnosing conditions, referring patients for specialist treatment, and managing ongoing care.
In addition, more than 50 NHS organisations said advanced practitioners are permitted to carry emergency “crash bleeps”, meaning they can be called to respond to urgent or life-threatening situations—responsibilities historically reserved for doctors.
Safety concerns and professional tensions grow
The scale of the trend has prompted warnings from medical professionals, who argue that substituting doctors with non-medically trained staff could compromise patient safety. Critics highlight the differences in training pathways, noting that doctors undergo significantly longer and more comprehensive education.
There have been documented cases where errors involving advanced practitioners contributed to patient harm or death, increasing scrutiny over how widely such roles are being expanded.
However, nursing leaders strongly reject the notion that advanced practitioners provide inferior care. Representatives from the Royal College of Nursing stress that APs are highly skilled professionals with postgraduate qualifications and play a vital role in modern healthcare delivery.
They argue that advanced practice is not about replacing doctors but about supporting multidisciplinary teams and improving access to care in overstretched services.
NHS guidance and real-world practice diverge
Official guidance from NHS England states that advanced practitioners should complement, not replace, doctors. Despite this, the data suggests that in practice, hospitals are increasingly relying on APs to fill staffing gaps caused by workforce shortages.
Trusts across England, Scotland, and Wales acknowledged that advanced practitioners are being used in roles typically associated with doctors, including out-of-hours services and specialist care units.
This divergence between policy and practice reflects the growing pressure on the NHS to maintain services amid rising patient demand and limited staffing resources.
Impact of workforce shortages on patient care
The reliance on advanced practitioners highlights the broader challenge facing the NHS: a persistent shortage of doctors across multiple specialties. Workforce gaps have been exacerbated by increasing patient demand, an ageing population, and difficulties in recruitment and retention.
Health leaders warn that without significant investment in training and hiring more doctors, the system will continue to depend on alternative staffing models to maintain service delivery.
At the same time, some experts argue that expanding the role of advanced practitioners can help improve efficiency and reduce waiting times, provided clear boundaries and supervision structures are in place.
NHS staffing crisis and evolving roles
The NHS has faced ongoing workforce challenges for more than a decade, with repeated warnings about shortages in both medical and nursing staff. Government strategies have included expanding training places, recruiting internationally, and developing new roles such as advanced practitioners to bridge gaps.
Advanced practice roles have grown significantly in recent years, particularly in emergency and primary care settings, where demand has surged. These roles are designed to provide high-level clinical care while supporting doctors and improving patient flow.
However, the rapid expansion of these roles has sparked debate about professional boundaries, accountability, and patient safety, with calls for clearer regulation and consistent standards across the UK.
As the NHS continues to adapt to increasing pressures, the balance between innovation in workforce models and maintaining high standards of care remains a central issue for policymakers and healthcare leaders.