I am an advanced clinical practitioner in acute respiratory medicine, and the British Medical Association’s (BMA) characterisation of practitioners like me as unsafe “substitute doctors” demands a response ( Safety fears as UK hospitals use nurses to cover for doctors due to shortage of medics, 25 April ).

Every shift, I assess and manage patients with severe chronic obstructive pulmonary disease exacerbations, pulmonary embolisms, pneumonia and acute respiratory failure, taking clinical responsibility in a consultant-led multidisciplinary team, underpinned by a master’s-level qualification and over a decade of specialist experience. This is not doctor substitution. This is advanced practice: a distinct, evidence-based clinical role that enhances patient care rather than compromising it.

The cases cited in your article (at Rotherham general hospital and a GP practice) represent failures of organisational governance, not evidence that advanced practitioners are inherently unsafe.…