Brief Summary

This study will explore the result of different skill-mix in ED/UTCs in England, to make recommendations about the best balance. Patient and public involvement (PPI) representatives have helped design the study. There will be an independent PPI panel who can feed in their views and experiences to all parts of the study. The panel will be run by an experienced patient and public involvement expert, who is a member of the core study team. The study will be split into four phases over two-and-a-half years. Phase One will find out in detail what the staffing models are in EDs/UTCs. The investigators will look at published research evidence and at NHS public documents, and will interview regional and national senior NHS clinicians, managers, commissioners and lay representatives. Then, information about staff which is already collected regularly across England will be analysed for patterns. What non-medical practitioners do and how independently they work in two different ED/UTCs will also be examined. The panel of patient and public involvement representatives and a panel of non-medical practitioners will help interpret these findings. The study will develop a system for classifying 'skill-mix' in each organisation and a way to measure how much support and supervision non-medical practitioners need. Phase Two will look at figures regularly collected from all NHS Trusts in England between 2017 and 2021, to assess whether different skill mixes lead to different patient outcomes. The number of patients who return again to the ED within a week is the primary outcome. Phase Three will involve looking in detail in six ED/UTCs. The investigators will collect in depth local data to add to the national data we looked at in Phase Two. This will include looking closely at staff records and patients' clinical records to illustrate more detail about skill-mix in the organisations and the outcomes for patients. The study plans to gauge how independently the types of practitioners assess and treat patients and to also survey and interview patients so that their experience can be understood, alongside the views of staff who will also be interviewed. Phase Four will pull all of the results together. The panels of patient and public involvement representatives and non-medical practitioners will help with this synthesis. The study aims to make recommendations on skill-mix and levels of independence that will deliver the best outcomes for patients, for staff and for the NHS.

Trial Health

On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment

840

participants targeted

Target at P75+ for all trials

Timeline

Completed

Started Mar 2021

Longer than P75 for all trials

Geographic Reach

1 country

2 active sites

Status

completed

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

4.1 years study duration

First Submitted

Initial submission to the registry

February 12, 2021

Completed

13 days until next milestone

First Posted

Study publicly available on registry

February 25, 2021

Completed

4 days until next milestone

Study Start

First participant enrolled

March 1, 2021

Completed

4.1 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

March 31, 2025

Completed

Same day until next milestone

Study Completion

Last participant's last visit for all outcomes

March 31, 2025

Completed

Last Updated

September 22, 2025

Status Verified

September 1, 2025

Enrollment Period

4.1 years

First QC Date

February 12, 2021

Last Update Submit

September 16, 2025

Conditions

Emergencies

Keywords

Emergency Service, HospitalWorkforceProfessional Autonomynon-medical practitionersHealth Services Research

Outcome Measures

Primary Outcomes (1)

Re-attendance
Re-attendance at the Emergency department following the index event
7 days

Secondary Outcomes (8)

Left without being seen
up to 8 hours
Time to initial assessment
Up to 8 hours
Time to treatment
Up to 8 hours
Total time
Up to 8 hours
Clinical investigation
Up to 8 hours
+3 more secondary outcomes

Other Outcomes (4)

Stakeholder perspectives
Up to 6 months
Staff perspectives
3 months
Patient satisfaction
1 and 28 days
+1 more other outcomes