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There is another group here, between primary care and A&E, which people seem to forget - parameds.
In the SW AHSN we work closely with the SW Ambulance service which, incidentally, has excellent, largely untapped data about call outs etc. They cover all 999 calls in our region and most of the 111 calls; of the resulting urgent calls to the home, nearly 60% are dealt with at home by parameds/advanced practitioners, only around 40% being sent to A&E.

Admittedly SWAST currently have amongst the best figures for home treatment in the country, but their strategic target is significantly to improve that percentage. I haven't seen it myself, but they say they have both good patient satisfaction scores and good outcomes.

This information raises questions. Should this activity be seen as urgent care, as primary care or an important part of integrated care? Should commissioners commission more of it? Do the 60% of visits treated successfully in the home really amount to primary care home visits? If the new primary care is increasingly to be delivered by pharmacists, physician's assistants and parameds, what does this mean in workforce planning terms?

All this needs further analysis, particularly in relation to cost benefit compared to the more traditional models of primary care. Integrated care is the SW AHSN's area of special interest; we will focus on this type of evaluation over the coming years and challenge prevailing orthodoxies, where appropriate, to encourage delivery of new ways of working.