Workforce Shortages Cannot Be Solved by Role Substitution Alone
Recent reporting has raised an important and uncomfortable question for the NHS and wider healthcare sector. According to The Guardian, FOI data obtained by the British Medical Association suggests that almost half of responding NHS organisations are using advanced practitioners to cover gaps in doctors’ rotas — including in high-pressure settings such as emergency departments, neonatal care and critical care.
The question this raises is not whether advanced practitioners are valuable. They are. It is whether any clinician, regardless of professional background, is being asked to operate beyond their training, competence or appropriate supervision because the system has run out of options.
NHS England’s position remains clear: advanced practitioners are a valuable part of the clinical workforce, but they should not be used as direct replacements for doctors. That is a meaningful distinction — one that has implications for governance, patient safety and the long-term sustainability of NHS workforce models.
This is not an argument against advanced practitioners
Advanced clinical practitioners, senior nurses, physician associates, pharmacists, AHPs and other specialist professionals all have a vital role to play in a modern healthcare system. The NHS of the future will need more multi-disciplinary working, not less — teams, built around patient pathways, prevention, community care, diagnostics, rehabilitation and safe discharge. It will also need to make better use of experienced clinicians who can work at the top of their licence.
But there is a crucial distinction between role optimisation and role substitution.
Role optimisation means designing teams properly, matching skills to patient need, ensuring clinicians work within clearly defined scopes of practice, and building governance around escalation, supervision and accountability. Role substitution happens when workforce pressure forces organisations to use one professional group to plug gaps in another. That may solve a rota problem in the short term, but it creates bigger risks if the model is not properly governed.
Workforce shortages are now one of the defining risks facing UK healthcare
Across diagnostic services, therapies, mental health, primary care, community provision and acute care, the same pressure is visible: too much demand, not enough available workforce, and increasing reliance on temporary fixes. The consequences affect waiting lists, patient flow, staff morale, safety and the ability to deliver new models of care.
The Health Services Safety Investigations Body has also highlighted the link between staff fatigue and patient safety, noting that fatigue affects healthcare workers across acute NHS hospitals and has implications for both staff and patients. Workforce models that simply stretch existing teams further do not resolve that risk — they compound it.
Safe workforce planning asks different questions
This is why workforce planning needs to move beyond simply filling shifts. A safe workforce model asks not just whether a gap has been covered, but whether it has been covered well. That means interrogating whether the right clinician is doing the right work, whether the role is clearly defined, whether escalation routes are safe, and whether compliance, referencing and competency checks are robust. It also means asking honestly whether a temporary solution is being used strategically or reactively — and whether it is masking a deeper structural gap.
Healthcare leaders are under enormous pressure to reduce waiting lists, improve access, manage budgets and retain exhausted teams. In that environment, creative solutions to rota gaps are understandable. But creativity must sit alongside governance.
The answer is not rigid professional silos
Stepping backwards into fixed professional hierarchies is not the solution either. The answer is to design smarter, safer multi-disciplinary teams, supported by strong workforce data, compliant staffing pipelines and partners who understand the difference between speed and risk.
For healthcare providers, this means workforce partners must do more than supply people. They need to help organisations plan capacity, understand shortage areas, access national and international talent pools, and build staffing models that protect patient safety as well as service delivery.
Where organisations are managing complex, multi-site or multi-professional workforce needs, a managed service approach can provide the governance infrastructure to ensure the right professionals are deployed in the right roles, with the right compliance and oversight in place. Workforce management at this level requires not just supply, but structure.
How Globe Workforce Solutions approaches this
Globe Workforce Solutions works with NHS trusts and independent providers to deliver compliant, scalable workforce solutions across medical, nursing, AHP and health science services. As an NHS Workforce Alliance-approved supplier across Clinical and Healthcare Staffing, Insourced Services and International Recruitment, our model is built around clinical standards as well as capacity. With over 100,000 patients treated and a 98% patient satisfaction rate, the measure of success is not just headcount, it is safe, effective delivery.
Our HEALTHCHECK system provides real-time performance and compliance reporting across locum delivery, giving providers visibility of workforce quality at the shift level — not just at the point of booking. That kind of governance infrastructure is increasingly important as organisations manage larger and more complex workforce models. You can see how this works in practice in our case studies.
Filling a gap is not enough
The healthcare workforce crisis will not be solved by one profession alone. It will not be solved by stretching existing teams further. And it will not be solved by asking clinicians to carry responsibilities that have not been properly designed, supported or governed.
It will be solved by building flexible, compliant and properly structured workforce models around real patient need — with doctors, nurses, AHPs, health science professionals, advanced practitioners and support teams all working together, but with clarity, safety and accountability at the centre.
If your organisation is managing complex workforce pressures across medical, nursing or AHP and HSS services, Globe Workforce Solutions can help you build a model that is safe, sustainable and fit for the future.