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Rimmer A. Physician associates are not a replacement for doctors, say RCP and GMC. BMJ. 2023; 383

Defining the scope of advanced practice

09 November 2023
Volume 32 · Issue 20


Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, considers the issue of defining and regulating the scope of advanced nursing practice

I am watching with interest the debate around the planned regulation of the physician associate by the General Medical Council (GMC). At the end of October, Rimmer (2023) reported that, at a specially convened meeting organised in response to a letter co-signed by more than 300 doctors, it was warned that the rapid expansion in the number of physician associates and anaesthesia associates posed risks to public safety and to ‘professional jurisdiction’.

My interest relates to the work that the Nursing and Midwifery Council (NMC) is undertaking, exploring if it should regulate the role of ‘advanced nurse’ or ‘midwifery practitioner’, with a key driver being public protection. Accepting that the NMC already regulates registered nurses and midwives, work is in progress to consider the scope of these roles.

Advanced practice is commonly described as a level of practice. Research by the Nuffield Trust (Palmer et al, 2023), commissioned by the NMC, identified 11 countries with ‘significant similar scopes of advanced practice as in the UK’, all of which regulate roles working to a similar scope of practice. The Nuffield Trust identified that ‘the greatest risks (across all clinicians) appear to relate to tasks such as diagnosis and interventions’ and that nurses in the UK are doing more work traditionally conducted by physicians than nurses in most other countries, suggesting that advanced practice could fall outside of their initial regulatory scope.

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