A government review of ambulance services to be published next week is expected to recommend a sharp reduction in the number of people taken to accident and emergency departments. Non-urgent call-outs, such as a cut finger or earache, are to be given to a growing army of emergency care practitioners (ECPs), who are trained to treat minor ailments outside hospital.

Peter Bradley, the national ambulance adviser to the Department of Health and leader of the review, told a conference last week that he could envisage a significant decrease in ambulance use.

A cut in the number of ambulances is not suggested in the review, although it will outline the importance of a significant reallocation of resources to make the service more focused on “treatment than transport”. It is known that Mr Bradley and George Alberti, the national director for emergency access, hope to increase the use of ECPs, who combine elements of nursing, medicine and the role of paramedics. ECPs travel alone in people carriers carrying the basic equipment for their work.

The national ambulance review will outline ways to reduce the number of patients taken to accident and emergency departments by a million a year.

Mr Bradley, the chief executive of the London Ambulance Service Trust, said that he wanted to see the service becoming a “mobile unit of the NHS taking healthcare to patients”.

His vision, outlined at the NHS Confederation conference and reported in Health Service Journal, includes doctors dealing with 999 calls in call centres, with ECPs taking on extra services such as diagnostics and blood sampling.

“We are going to see a big shift from not only providing clinical guidance in the field but also in the control centres — dealing with patients at source rather than elsewhere,” he said. Mr Bradley said that in London ECPs could rise from 3 to 30 per cent of the NHS workforce by 2011. Less than half of all callers would be taken to A&E, compared with three-quarters now.

“Maybe in 2011 we’ll have only half as many (ambulances),” he said. “We’ll have ECPs singly responding in people carriers. We’ll be a lot less reliant on a big 3-tonne ambulance going out at £140,000 apiece.”

Last night the Department of Health denied that any ambulances would be cut as part of the overhaul of emergency care.

The BBC Radio 4 Today programme yesterday highlighted discrepancies in ambulance response times by different trusts.

The programme claimed that many trusts do not start the clock until 1½ or 2 minutes after the call is received, and in at least one case the delay may be as much as 3 or 4 minutes, distorting results.

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