Half of NHS hospital trusts using non-doctors in doctor rotas

Nearly half of NHS hospital trusts are using non-doctors in their doctor rotas, according to Freedom of Information (FOI) responses to the British Medical Association. The revelation is a continuation of the Starmer government’s scandalous push to ‘downskill’ the NHS and reduce staff costs to allow greater profits for private providers.

An absolute shambles in the NHS

Starmer’s health secretary Wes Streeting is an ardent advocate of the expanded use of ‘medical associates’ (sometimes called ‘physician or anaesthetist assistants’) and ‘advanced practitioners’. Streeting, who has accepted huge amounts of cash from the private health industry, claims this is safe for patients. Labour’s own data show it to be “high risk” to patients, but Streeting has told doctors who protest that it’s none of their business.

Streeting is so committed to this that he has pressured the General Medical Council (GMC) to remove the need for medical training to be GMC-registered. He also says he will let the NHS ‘die’ if it doesn’t submit to such ‘reforms’ as part of his ten-year slash-and-burn plan.

The new FOI responses show that the net effect is that the sick are made to see non-doctors with a fraction of a real doctor’s training. The BMA received responses from 85 of the UK’s 202 NHS hospital trusts. Of them, 48% confirmed they are using ‘advanced practitioner’ roles to fill out doctor rotas.

This number does not even include those using ‘medical associates’, who have just two years’ basic training. ‘Advanced practitioners’ are nurses, paramedics, physiotherapists and pharmacists who complete an “Advanced Clinical Practitioner (ACP) apprenticeship” or similar bolt-on training module. As the BMA notes:

While many are experienced in their base profession, working on medical roles is beyond their scope of practice.

People are dying

However, they are being used well beyond their qualified scope, as is also the case with ‘associates’, meaning many patients are being treated by people they think are doctors but aren’t. As of July 2025, at least six have died as a result.

BMA council chair Tom Dolphin said the findings prove NHS management’s ‘haphazard’ approach to staffing:

Our colleagues in advanced practice roles are valued members of our multidisciplinary teams. Yet our research reveals an NHS management that will risk patient safety to push these professionals out of what they do best and use them as spare capacity to fill up understaffed doctors’ rotas. While other healthcare roles can be enhanced within safe limits, this must never encroach into areas where a doctor’s training and expertise is required.

What is especially concerning is just how slapdash the NHS’s approach is. Many trusts have clearly and sensibly told us they would not put a non-doctor into the role of a doctor. Other trusts have unashamedly responded that they have done. That these responses split almost down the middle is an indictment of an approach by Trusts and the NHS which means that where you live determines whether you will be seen by a doctor or by someone else for the same condition.

This is a potential disaster for everyone involved. Advanced practitioners are being asked to do jobs they shouldn’t have to. Patients are being given no clarity about who is treating them and what level of care they’re meant to be getting. Doctors are being left unclear on where the lines are drawn. The whole thing is a haphazard mess brought on by an absence of workforce planning and rational thinking about who can do what.

Patients deserve a good standard of care whichever hospital they happen to live near. They shouldn’t have to worry about whether the local managers have asked non-doctors to deliver care that only uniquely qualified doctors can safely deliver. ‘An NHS stretched to breaking point is no excuse. Better regulation and clear and uniform scopes of practice to stop this blurring of professional lines are needed, so no patient comes to harm.

The Nursing and Midwifery Council agrees. It told the BMA in March 2026 that “advanced practitioners are not a substitute for medical practitioners”.

Streeting has a lot to answer for

The use of these sub-medical roles as medics is a core part of the government’s ‘integrated care services’ ICS) plans to close hospitals and ration treatment. ICS used to be called ‘Accountable Care Organisations” (ACOs) after the dangerous US cost-cutting system it copies. However, after the US ACO scandal became known in the US, NHS ACOs were renamed to ICS. ICS even rewards NHS trusts and private providers for not treating the sick, putting healthcare further out of reach for those who need it.

To the Starmer government, cost-cutting to enable private health corporations to make fatter profits trumps the needs of patients and the future of the NHS, every time. No matter how it’s dressed up or what terms they invent to disguise it.

Featured image via the Canary