NHS medical director proposes increased role for ambulance services

The National Medical Director of NHS England, Sir Bruce Keogh, has proposed an increased role for ambulance services in the provision of emergency and urgent care in England.

Sir Bruce Keogh’s report on the first stage of his review of urgent and emergency care, published 13 November 2013, has called for the development of 999 ambulance services so that they become mobile urgent treatment services, noting that paramedics now have the skills and equipment that would only be done by doctors 10 years ago.

In a letter to Health Secretary Jeremy Hunt and NHS England Chair Sir Malcolm Grant, Sir Bruce says:

‘Our vision is simple. Firstly, for those people with urgent but non life-threatening needs we must provide highly responsive, effective and personalised services outside of hospital. These services should deliver care in or as close to people’s homes as possible, minimising disruption and inconvenience for patients and their families.’

Both the College of Paramedics (CoP) and the Association of Ambulance Chief Executives (AACE) have welcomed the report, and emphasised that increasing demands on ambulance services highlights the need for further investment into the training and education of paramedics.

Prof Andy Newton, chair of the College of Paramedics, said:

‘Key roles, like that of the specialist paramedic roles in urgent care, now urgently need support with further investment and critically the development of prescribing for paramedics, another key area highlighted in this NHS England report.’

Association of Ambulance Chief Executives managing director, Martin Flaherty OBE, said:

‘This will require further investment in the training and education of paramedics and other ambulance staff together with a review of the overall capacity of ambulance services. This will ensure that they have the resources needed to resolve the patient’s issue without taking them to hospital.’

The report also suggests that a two-tier A&E system should be introduced. The biggest 40–70 units would be called ‘Major Emergency Centres’ and designated to deal with heart attacks, strokes and other serious injury, while the remaining 70–100 A&Es would be ‘Emergency Centres’ and deal with less serious conditions.

Taken from Journal of Paramedic Practice, published 26 November 2013.