The statement is supported by CCLG and is issued in response to the publication ‘Preventing doctor substitution’ issued 29th January 2026 by the BMA.
The starting premise of this publication is the statement that the BMA supports multidisciplinary working, and yet the subsequent arguments are divisive. The statements directly contradict the ethos of true MDT working and the commitment within the NHS 10-year plan towards an NHS workforce that is fit for the future which includes the development of advanced practice models for nurses and other professionals. Any survey to understand the status quo, to be a true reflection of reality, should be launched from a neutral position to maintain objectivity. Yet the survey proposed by the BMA is generated from language that is divisive and biased towards a negative view of the impact of non-medical clinicians on both doctors and patients, thus reducing the credibility of findings.
MDT working within the NHS should not operate within a hierarchy but rather reflect the values of team working that harnesses the strengths of each role and profession. Advanced Clinical Practitioners (ACP) work in line with the 4 pillars of advanced practice, and as with any clinician within the limits of their competence, thus ensuring that the safety and quality of patient care is not compromised. We agree that there must be role clarity for patients, adequate supervision and ongoing professional development for all healthcare professionals. We also agree that role substitution based purely on cost saving is not acceptable, but using well trained, competent multi-professional teams whose skills match the requirements of a given situation, can offer cost efficiencies and free up essential medical professionals’ time.
The ACP SIG at CCLG advocate that advanced practitioners working in both paediatric and TYA (teenage and young adult) oncology, utilise the RCPCH (2025) Paediatric and child health advanced practice area of specific capability and curriculum framework, alongside the speciality specific CCLG (2022) Advanced Clinical Practitioner paediatric & haematology capability document, to enhance safety. Advanced practice is now well embedded into paediatric and TYA oncology MDT working across most UK centres, reducing waiting times in many locations and with good results in local patient satisfaction surveys. Clear stratification of care for example in leukaemia clinics, with Advanced Nurse Practitioners (ANPs) reviewing low risk children on maintenance therapy, managing maintenance therapy dosing within clear guidelines, has created additional medical Consultant time to spend longer with more complex cases in the clinic. This has been possible due to support from medical colleagues who value the fact that each role within the MDT contributes to patient experience and outcomes when they work well together.
One advantage of ACP role in specialties is that the individuals enable continuity, maintain institutional knowledge and have a depth of knowledge in the speciality. This can positively impact on junior doctor education and training, as it complements the medical role which benefits from rotational learning and breadth of knowledge.
It is proposed that rather than attempting to create a divisive stance, the BMA should work alongside organisations like the RCPCH, RCN and CCLG who support advanced practice to harness the wealth of knowledge and skills within the NHS on how to safely integrate new ways of working. This can create a workforce as enshrined in the NHS long term plan that is sufficiently robust to meet the health needs of the nation in terms of optimising both the safety and quality of patient care, but that is also financially sustainable. We hope therefore in order to meet this objective that on receipt of this position statement that the BMA will agree to a series of meetings with panels inclusive of both medical and non-medical clinicians and patient representatives from which to achieve this.As members of the ACP SIG we would be happy to participate in this process.
