A charter for air ambulances is fuelling debate over the future roles of air and land ambulances. Four independent air ambulance charities have signed up to new standards including a commitment to 'pre-hospital care doctors' on flights.

The first UK helicopter emergency medical service charter covers skills, additional training and supervision. It has been adopted by Great North Air Ambulance and services for London, Essex and Hertfordshire, and Kent, Surrey and Sussex.

The charities believe on-board doctors will help save lives and cut costly hospital transfers.

Conventional crews such as London Ambulance Service trust are trialling new ways of working, including taking some patients with coronary symptoms straight to specialist treatment centres. Most land ambulances do not have on-board doctors.

Kent, Surrey and Sussex Air Ambulance chief executive David Philpott told HSJ that fewer emergency departments and increased traffic, combined with efforts to improve patient care, will mean a move away from simple 'swoop and scoop' air ambulance services.

Doctors at the scene can refer severely injured patients directly to specialist centres rather than the nearest hospital. He called on the government to increase funding to reflect this shift in practice.

Mr Philpott estimated each on-board doctor costs up to£300,000 a year, which would mean an annual bill of nearly£7m to fund doctors on all 23 air ambulance helicopters operating in the UK. All 15 UK air ambulance services operate as charities.

London's Air Ambulance chief executive Andrew Cameron said services will increasingly be about getting senior medics to patients at trauma scenes to stabilise the injured.

A Department of health spokeswoman said the DoH recognised air ambulances could be 'an effective way of getting better and faster access to hospitals and valuable in supporting inter-hospital transfers', and added that the NHS already met the cost of most clinical staff. She said: 'It remains for NHS trusts to decide whether they provide any additional funding to air ambulance charities.'

A spokesman for the Ambulance Service Association said it was unrealistic to have doctors on all land ambulances but paramedics would welcome the chance to play a greater role in referring cases to a specialist service rather than the nearest district hospital.

'Our mandate is to take people to the nearest hospital. If paramedics were properly trained and skilled then certainly they could play an increased role in deciding where a patient should be taken.'