Medical Mistake Claims - Simpson Millar LLP

Too Few Nurses Leads to Medical Mistakes

Author: Neil Fearn  Bullet  Dated: 30/05/2013

Care provider ‘Harmoni’ is Britain’s biggest out-of-hours care provider for medical practitioners to hospitals and medical bodies for overnight shifts. They are responsible for the care of millions of patients and makes around £100 million a year from NHS contracts.

Reports from an anonymous whistleblower have criticised the care provider for overworking staff members and the use of nurse practitioners in the place of GPs.

Nurse Practitioners hired to fill the place of GPs

GP from Somerset, who works for Harmoni, has given reports of nurse practitioners being used to work 8 hour overnight shifts in place of GPs. The whistleblower also reports of how one advanced nurse practitioner can be made responsible for around 250,000 patients.

Although, advanced nurse practitioners have undertaken extra training in advanced medical practice to allow them to carry out the normal tasks of a qualified doctor, critics say they cannot be used to replace a fully trained GP and attend emergency callouts.

The whistleblower tells of how he was once telephoned by a nurse practitioner who was desperate for advice on treating a patient with a complicated condition, as she had not been properly trained to do so.

He also speaks of how terminally ill cancer patients were made to wait 8 hours for a doctor to visit them at home in order to administer pain relief.

Understaffing in the NHS

The use of Harmoni staff has highlighted the problems with staff shortages in the NHS. The Safe Staffing Alliance said that on a regular basis there is only 1 registered nurse to 8 patients.

However, a study by researchers at Southampton University found that at this ratio, wards would experience around 20 more deaths a year than better staffed hospitals.

The Alliance goes on to state that this level of staffing cannot provide patients with the compassionate care and dignity which they have come to expect.

Calls have been made for the government to introduce a mandatory minimum ratio for qualified nurses to patients or a skill mix of un-registered and registered staff. Concern about the lack of an objective and rational ‘universal formula’ for staffing has been an on-going issue for many years and has been raised by a number of professional bodies including the Royal College of Nursing (RCN).

However, the government has continued to favour leaving the decision of staffing at the local level. This is in line with policies to give autonomy to NHS organisations and the Foundation Trusts.

What appears to be highlighted here is that the role of a GP is being replaced by a Nurse Practitioner which is inappropriate and unsafe. It should be highlighted that today a nurse is expected to be the first line of defence that a patient has against unsafe medical practices. Nurses and nursing staff take responsibility for the care that they provide and have to answer for their own judgements and actions. Therefore the Nurse Practitioner must be sure that they have the skills and abilities to perform the role asked of them competently.

You can find out about what you should expect from professionally qualified care staff by looking at their ‘codes of practice’.

A Code of Practice is agreed and published by a professions governing body and it sets out the standards and values that professionals are required to maintain in the delivery of their professional practice.

For example the nursing code of practice can be found at: and the General Medical Councils code of practice can be found at:

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