• admission avoidance
• advanced practitioner
• doctors in PHC
• patient support

As demand for healthcare in the UK rises, the challenges become those of trying to meet this demand in a patient-centred way whilst managing changes in the delivery of healthcare to enhance the effectiveness and efficiency of services. This requires an increased level of understanding and cooperation between different healthcare professionals, provider organisations and patients. The changes mean reconsidering traditional roles and where appropriate, redefining professional roles, areas of responsibility and team structures, and renegotiating the boundaries between acute and community care. Government policy has emphasised the need for the NHS to provide increased patient choice, ease of access and delivery of a high-quality service. This is relevant to providers of emergency care services which need to develop new ways of meeting patient needs closer to home and work environments. In emergency care, ambulance services have had to consider new types of responses to those usually provided. Policy initiatives have meant local NHS organisations assuming responsibility for managing and monitoring how local services respond to urgent and non-urgent 999 ambulance calls. Alongside this, the NHS Long Term Plan emphasises the importance of integrating care through a more joined-up multidisciplinary approach that spans boundaries between primary and secondary care but aims to keep patients out of hospital.

At the same time, we are facing workforce crisis across the NHS. This is especially the case in emergency medicine. Failure to seek new opportunities to develop the workforce will only lead to further attrition. The challenge is how to do this in a sustainable, cost-effective and generalisable manner that leads to clear benefits for the workforce, services and patients. Currently, the emphasis is on the deployment of non-medical practitioner roles in EDs and ambulance services, such as …