Anyone who's worked in the NHS for a time can relate many tales of incompetence on the part of doctors, but that doesn't mean they're all useless. Some doctors are trained better than others - not all medical schools (here or abroad) are equal. And some doctors are simply more intelligent or better suited to their posts than others. The same applies to nurse practitioners - some are better experienced, better trained, or just better than others. Nurses have been taking over roles that were once the remit of doctors for decades - IV drug administration, cannulation, venepuncture, nasogastric intubation, urinary catheterisation and defibrillation to name just a few. If things hadn't "dumbed down" to allow them to do so, our A&E doctors would never do anything else - they simply wouldn't have the time!