NHS ambulance leaders are calling for a fresh approach to designing and delivering urgent and emergency care, including an expanded role for paramedics in helping to treat people at home and ease pressure on hospitals.

A vision for the NHS ambulance sector, developed by the Association of Ambulance Chief Executives (AACE) in partnership with NHS Providers and NHS Confederation, says ambulance services' core remit will always be to provide emergency response to those who have a life-threatening health need and to major incidents.

However this is a relatively small proportion of what ambulance services do, and the report finds that there is great potential in extending and formalising a wider remit in urgent and emergency care (UEC) which could help solve some of the key system pressures, reduce the risks for patients and offer a more positive, supportive and productive environment for staff.

The report calls for a stronger focus on prevention and a shift in the balance of investment to out-of-hospital services when designing urgent and emergency care. Within this, it says there is greater potential for ambulance services to develop with two clear remits, as:

1. The lead coordinator and navigator for access to UEC and support agencies, making efficient use of multi-professional, integrated clinical hubs and assessment services at system level, and
2. Responders to patients needing out-of-hospital care, with more direct referral pathways to other parts of the system, and advanced skill sets and paramedicine models to safely keep more patients at home.

It says ambulance services are well placed to become "system leaders" in this change because they already have:

• 24/7 regional/national infrastructure enabling them to see issues, gaps, and connections that others cannot
• Highly skilled, increasingly multi-professional workforces, with a range of skill sets able to triage and operate autonomously in all environments
• The trust of the public and interaction with patients in their own environments, and the ability to engage with 'hard to reach' patients
• Interoperable telephony and connectivity infrastructure, supporting the interface with all parts of UEC across primary, secondary, community and mental health care
• Data insight in real time that can provide early warning intelligence across local systems.

The report concludes that investment to increase recruitment and development of paramedics and the wider ambulance services' clinical workforce could provide good value for money and reap rewards in getting patients access to the most appropriate care first time.

The report includes several case studies setting out the benefits of this approach, but it says these approaches are being implemented in small pockets across the country and often not part of an overall UEC system strategy.

The managing director of AACE, Anna Parry, said:

"Having developed this vision with our members, we really welcome the support of NHS Providers and NHS Confederation in engaging with our health and social care partners to increase understanding of our ideas and stimulate new conversation and constructive thinking – with the ultimate aim of providing the best possible care to our patients and populations."

The chief executive of NHS Providers, Sir Julian Hartley, said:

"We know there is real potential in consolidating the role of ambulance services in coordinating and delivering urgent care, bringing benefits for patients and staff. This can be a key ingredient of a wider shift in the NHS towards a stronger focus on prevention and more care provided closer to home. I know this is something that trust leaders across the provider sector want to see."

The chief executive of NHS Confederation, Matthew Taylor, said:

"For most people, being treated at or as close to home as possible is what is what is best for their health and how they want to be cared for. Ambulance providers have great potential to help solve some of the key pressures on the NHS and improve how urgent and emergency care is provided for their populations, with a greater shift towards prevention and treating people at or closer to home. We are already seeing many examples of where they are working successfully with partners to make a positive difference to the care people receive and this needs to continue to be supported."