The number of ambulances on the roads could be halved within six years under radical proposals to be unveiled next week.
The national ambulance review will outline ways to cut the number of patients taken to accident and emergency departments by 1 million a year.
More 999 callers will be dealt with by doctors based in call centres, and the number of ambulances could be drastically reduced. They would be replaced by emergency care practitioners (ECPs) in people carriers delivering help to non-life threatening call-outs.
London Ambulance Service trust chief executive Peter Bradley, who is leading the review, told a session of the NHS Confederation conference last week that he wanted to see the ambulance service becoming a 'mobile unit of the NHS taking healthcare to patients', providing extra services such as diagnostics and blood sampling.
'We are going to see a big shift from not only providing clinical guidance in the field but also in the control centres; dealing with patients at source rather than elsewhere, ' he said.
Mr Bradley, who is national ambulance adviser to the Department of Health, said that in London alone ECPs could rise from 3 per cent of the workforce now to 30 per cent by 2011.
Less than half of all callers would be taken to A&E, compared to threequarters now.
Referring to the situation in the capital, he said: 'Maybe in 2011 we'll have only half as many [ambulances]. We'll have ECPs singly responding in people carriers.
We'll be a lot less reliant on a big ambulance going out at£140,000 a piece.' He added: 'The benefits will be 1 million fewer patients taken to A&E with better care.' The review will call for the ambulance service to be more integrated with the rest of the NHS, with better systems to ensure that GPs are informed when elderly people fall but do not get taken to hospital.
Training will give more emphasis to non-life-threatening emergencies which, for example, make up 92 per cent of London's case-mix but comprises less than one week of the 16week technician training course.
He added that 'unsustainable' smaller ambulance trusts could be merged with neighbours. HSJ understands the plan is to make ambulance trusts coterminous with strategic health authorities.
'There are probably too many ambulance services in England, ' Mr Bradley said. 'The strategic capacity of some of our smaller organisations is difficult to manage. We'll be having a look at the structures to make sure they are fit for purpose for the future.' Pippa Bagnall, DoH programme director for reforming emergency and urgency care, said: 'The whole notion of moving from a transport system to a treatment system is something we all have to work to.' National director for emergency access Professor Sir George Alberti agreed that the number of 'blue light' ambulances was set to be drastically reduced. He told HSJ: 'Fewer ambulances would be the natural development of what we are doing.' He confirmed the review would also look at ways to ensure response times quoted by trusts are accurate.
'We want to get uniformity and make sure timings are an honest reflection of what is going on, ' he said.