Felt an urge to pitch in here. And yes I'm still working as an ECP and still wondering what the hell I'm doing. I remember reading the BBC article and having a little chuckle. ...emergency care practitioners, who have a wider range of skills than paramedics. Yeah right! By skills they mean we can do a bit of minor wound closure (suturing, staples and steri-strips) and some male re-catheterisation. The other 'skills' are how to take a (better) history i.e. spend 10-15 mins rather than the 30 seconds the management want paramedics/EMTs to do, plus be able to write up copious notes on everything rather than tick the boxes on a patient report form. They can prescribe more drugs, take blood tests and refer patients to GPs Again whoopie!! Drugs like paracetamol, gaviscon, co-dydramol, (stuff you can buy at the chemists) plus tablet versions of drugs that paramedics already administer in other forms (gtn, diazepam). OK we do carry some antibiotics as well but our guidelines are pretty clear about what we can us them for and, to be honest, most are for animal bites. Yes you read that correctly folks. We carry three different anitbiotics and about the only thing we can use them for are animal bites. I've only done 3 jobs in 11 years that involved animal bites and all were severe enough for the patient to require more than some anti-biotics. In the end, the vast majority of these extra drugs go out of date without ever being used. As for blood test. No, we don't do them. Even if we did they'd still have to be sent off to a lab for analysis so what's the point. We do 'do' urine tests though, but can only treat female UTIs (get quite a lot of those) as we do carry trimethoprim. As for refering to GPs. Well, most ECPs calls are Out of Hours. Which by definition means the GP is not around so a GP referral is not going to happen. Despite the claims from some of my colleagues (those with the big 'S' on their shirts and their underpants worn on the outside of their uniform) we are NOT doctors. I worked it out that adding together my EMT + Paramedic + ECP training the total comes to about 10 months full time. Compare that with the 10 years to train to be a GP. As the eminent Dr Crippen points out "we don't know what it is we don't know". My medical knowledge is really no more advanced than a paramedic coz you don't really learn much more on the ECP course. The general rule of thumb is "is the patient BIG sick or Little sick". If the former then they go in, if the latter then they can stay at home. Get a bit of advice from the duty doctor in Control and pack them off to their GP in the morning. Easy. Job done. On a positive note - yes I do leave about 40-50% of patients at home. They're not BIG sick, just usually need some re-assurance, some minor wound care etc; enough to get them through the night or over the weekend so that they can see their own GP. But Tom's right, it takes as long, if not longer, for me to complete all the paperwork; patient report form, letter to GP, clinical audit report etc, than it would to take them down to the local hospital. On the plus side though you often get offered a cup of tea and don't get hassle from control about why you're taking so long at scene.