Thank you for requesting a commentary directly from the British Association for Immediate Care (BASICS). BASICS is always delighted to consider any proposal that improves the delivery of immediate care in the UK.

In this article, the authors have provided a vast array of proposals, culminating in a licensing system for practitioners of immediate care based on an examination system. Our association has long recognised the need for the “licensing” of practitioners and introduced an accreditation programme that has been running for over 6 years. The programme encompasses a wide range of practitioners. It recognises that the PHEC course is a minimum standard and we have always encouraged regular responders to undertake the Diploma examination. Furthermore, it recognises experience. We have always discouraged the use of untrained staff to work in the pre-hospital environment. Unfortunately, there seems to be a persistent misconception that hospital A&E staff, many of whom hold high academic qualifications, can simply and instantly adapt their practice to the out of hospital environment. This misconception must be corrected, and only trained and accredited individuals be sent to a pre-hospital incident.

BASICS, in using its accreditation process, has also recognised the large number of practitioners needed to provide even the most rudimentary immediate care assistance. We have repeatedly undertaken recruitment drives to encourage those interested in immediate care to register, train, and become accredited. We do have to concede that there are vast areas of the UK, both urban and rural, that do not have this type of voluntary emergency medical cover, and rely totally on the skills of the ambulance service paramedics and technicians. BASICS has had to recognise that, although an examination based accreditation process would be ideal, this could result in a large number of very experienced practitioners becoming non-operational. Instead, we have continued to encourage those interested in immediate care practice to train, to update, and to honestly assess their level of participation. It is essential that immediate care practitioners should only practise within the boundaries of their training/experience. This does lead to a variation in the level of accreditation, but we have to recognise that immediate care is such a huge subject, covering a vast geographic environment, that it would be foolhardy to expect a large number of highly trained, experienced individuals to be instantly and constantly available throughout the UK.

If immediate care is going to progress, then our association, apart from supporting the examination system, would wish to see the development and implementation of a competency based accreditation system. This would allow individual practitioners to develop their skills along the line that was of particular interest to them and of relevance to their own individual practice. If enough practitioners registered on a competency based system in a particular area, then cover could be sustained, tasking would be appropriate, and there could be development of team practice together with team training. Individuals with a declining skill base could be supported through sparse times, and local schemes would become empowered to make treatment and management recommendations based on hard evidence of good practice rather than an aging examination certificate. This approach does not hinder the few who wish to make a primary career of pre-hospital medicine, who should follow a pathway similar to that described by the authors in the manuscript, thereby becoming the true “consultant” in this field.

Finally, our association has, on a number of occasions, examined the terminology of the title of this sub-specialty. We have remained with the term “immediate care”, as we believe that this most accurately describes the work that our membership undertakes. Although there was some confusion with “intermediate care”, this now seems to have passed, following some careful explanation of the differences. The terminology proposed by the authors of “Pre-Hospital and Retrieval Medicine” would seem to limit the scope of practice and is also open to misinterpretation. However, we do support the proposal of a specialty recognised for its true worth and value in saving and preserving life in this complex, unpredictable, and difficult environment.