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Very useful comments, consultant physician. I must confess to struggling with this re-design myself. Our MIU was really a dressing station - we didn't have proper medical cover, no XR, no community ECP, all our PGDs for nurse prescribers needed updating...... Our OOH was good but winter pressures were a nightmare and on the whole it felt like trying to put a jigsaw puzzle together where you have a shared understanding of the picture on the box (we have strong clinical leadership locally and the Boards were all supportive) but no one could quite fit all the pieces together properly because of various conflicting policy drivers.