1. London Ambulance Service NHS Trust What are the alternatives for patients who are not life threatened? Clinical Telephone Advice Walk in Centres Minor Injuries Units Intermediate Care Falls teams District nurses Mental Health Crisis Intervention Teams Primary care Social services NHS Direct

2. London Ambulance Service NHS Trust Requires us to change: Provide telephone advice to callers with non-serious conditions Develop referral pathways Send a professional who is trained in the recognition and treatment of non-life threatened, but often complex, patients

3. London Ambulance Service NHS Trust Education for Emergency Care Practitioners St Georges Medical School/Kingston University

4. London Ambulance Service NHS Trust Around the Country Merseyside – relatively clear care pathways West Country – strong educational package & some extensions in practice Warwickshire – v. competent practitioners, open access routes to role, clerking into acute sector Staffordshire – clear location in demand patches, CPOs senior role in service, patient focused ethos Sheffield – rotation through control & MIUs, also focus on older peoples needs East Anglia – strong links with GPs non escalation of cases unless necessary = basic principle, extended practice