The 'Front End Model', which I've heard has been quietly shelved. You are right though - this would be one solution, the problem being that there is a perception (if not a reality) that should anything bad happen to the patient the road staff attending would be 'hung out to dry'. I don't think that it's just confidence, I think that we realise that we aren't doctors, in training school I was told that we weren't supposed to diagnose, let alone leave people at home. Then you need to pay for the training as well as take people off the road for the training courses - essentially you would be training (and then employing) a large number of ECP-types. You'd also need to set up the right care pathways for referral. Essentially you'd need to have a fleet of GPs in cars whizzing around everywhere in eight minutes. It would be nice to have such a system in effect, but given the amount of time to properly assess and treat/refer a patient it'd be quicker for the service to run them to hospital...