We are aware of a recent survey by the British Medical Association (BMA) entitled ‘Preventing doctor substitution’. We know this survey has prompted questions and concerns from nursing staff, medical professionals and other health and care professionals.

The RCN position is clear. Advanced level nursing describes a level of practice which can only be delivered by registered nurses with additional knowledge and expertise. It is underpinned by a comprehensive range of knowledge, skills and capabilities within each of the four pillars of nursing: clinical practice, education, research and leadership.

Advanced practice nursing is provided by district nurses, clinical nurse specialists, nurse practitioners, consultant nurses and other roles. District nursing has been established for 150 years - and it is differentiated from other levels of nursing by the nurse’s expertise in applying highly developed theoretical and practical knowledge to complex, unfamiliar and unpredictable situations.

The RCN believes that role definition is vital in all spheres of professional practice. It is also essential that patients using services understand the difference between the roles of the professionals caring for them.

We will continue to make a strong defence of this area of nursing work and the issue will be debated at our annual Congress in May 2026, at the request of members.

Nurses working at an advanced level are not substitutes for any other profession. They are autonomous professionals.

Find out more about advanced level nursing.