Ambulance services are experiencing increasing demand for response to emergency calls. In response, they have increased the proportion of patients not conveyed to an emergency department (ED). Alternatives to transporting patients to an ED include the provision of telephone advice rather than dispatching a vehicle (‘hear and treat’), treatment at the scene (‘see and treat’) and transport to other facilities (‘see and convey elsewhere’). There is considerable variation in the rates of different types of non-conveyance, and in non-conveyance overall, between ambulance services in England. Understanding the reasons for this variation between services can help identify ways of improving service delivery across all ambulance services. Approaches to commissioning may influence the amount of non-conveyance undertaken in different ambulance services.Methods
As part of a larger study we undertook qualitative interviews with ambulance service commissioners (or appropriate commissioning support staff) in the 10 larger ambulance services in England, to identify potential factors that may explain variation in rates of ambulance non-conveyance. 10 commissioners took part in the interviews. Telephone interviews were conducted and transcribed verbatim. Framework analysis was used to analyse the data.Results
Ambulance commissioners reported a range of successes and challenges in relation to commissioning non-conveyance services. Successes often related to engaging, collaborative and motivational working relationships between the commissioner and the ambulance service. A range of challenges were reported including access to information to enable decision making, the scale of the geographical commissioning area, collaborative working, complexity, lack of resource and their role as quality enforcers and reporters. There was variation in how different commissioners reported their approaches to commissioning for non-conveyance.Conclusions
These findings highlight the challenges facing commissioners. This variation in commissioning approaches will be included in a wider model of factors affecting variation in non-conveyance.