Lord Darzi's recent report summarises the challenges for the National Health Service (NHS) in the 21st century: rising expectations, demand driven by demographics, continuing development of the “information society”, advances in treatments, the changing nature of disease, and changing expectations of the workforce.1 These challenges are all relevant to the provision and development of emergency and urgent care services in the future. Perhaps, most acutely, as demand for emergency care in the UK rises, with an increasing proportion of callers with underlying chronic conditions, the challenges become those of meeting demands in a patient-centred way while managing changes to enhance the effectiveness and efficiency of the delivery of services across the spectrum of care. Meeting these challenges requires an increased level of understanding and cooperation among different healthcare professionals, provider organisations and patients. The changes mean reconsidering traditional roles and areas of responsibility and renegotiating the boundaries between acute and community care and between health and social care.

Despite the introduction of Minor Injury Units (MIUs), Walk-in Centres (WIC) and NHS Direct, attendances at emergency departments (EDs) continue to rise each year, as can be seen in figure 1, and calls to ambulance services have risen at an even faster rate.2

As well as in response to rising demand, change in the UK has been driven by external factors such as the General Medical Services (GMS) contract introduced in April 2004 and the introduction of …