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AIM: This paper examines the historical background and context to the doctor-nurse substitution debate, and then addresses the sufficiency assumptions inherent in the new nursing roles. BACKGROUND: The NHS Executive considers 'new nursing roles' as a means of substituting part of the doctors' skills. Whilst the literature abounds with professional debate related to the desirability of nurses extending their roles, the underlying assumption of a sufficiency of skilled nurses is not considered. METHODS: The NHS hospital workforce data for the year 1994/95 were analysed and the changes in the overall numbers of doctors and nurses available for work were calculated as the doctors' hours were progressively reduced. FINDINGS: The changes in skill mix were compared; firstly, as a result of the estimated potential reductions in nurses available to undertake the nursing function as movements up the nursing skills spectrum occurs, and secondly, as a result of the alteration in the balance of available skilled staff. CONCLUSION: The policy assumption that suggests that a sufficiency of nurses is available for doctor substitution, whilst still allowing the nursing element to function may be false.
Calpin‐davies et al. (Mon,) studied this question.