Scope of registration

Description

This regulated activity covers two main service types:

• transport (ambulance) services for the primary purpose of carrying a person who requires treatment
• remote medical advice services that give medical advice or triage by telephone or email in cases where immediate action or attention is needed, and are provided by a body established for this purpose.

Transport services

This regulated activity covers services that involve a vehicle designed for the primary purpose of transporting people who need treatment. The nature of the vehicles used determines the need to register.

The term 'designed for' applies to vehicles that are used to transport people who need treatment where this was the manufacturer's original design, as well as vehicles that have been made suitable for this purpose (for example, displaying livery to show what they are and/or being modified).

You need to register for this activity if your transport services are provided in vehicles that meet this definition. This applies whether ambulance transport is the only regulated activity you provide, or if you provide other services as well as transporting patients.

Air ambulances and water ambulances

These are also covered by this regulated activity. But you are exempt and do not need to register for this activity if:

• the aircraft you use is registered with the Civil Aviation Authority and you are not providing treatment to a patient
• the transport is not carried out in England or is carried out under travel insurance arrangements.

Read the General exceptions from registration including Third party exemptions for more information on the exception related to insurance.

What this regulated activity does NOT include

• Transport services provided in vehicles with a different primary purpose (such as taxis, volunteers using their private cars, or mortuary vehicles and Dial-A-Ride vehicles), even though they may be registered with the Driver and Vehicle Licensing Agency as ambulances.
• Search and rescue transport services. This is because the service is provided under arrangements made on people’s behalf by a government department.

Although this regulated activity relates to transport, it does not cover other regulated activities that may be provided in or from a vehicle, such as Treatment of disease, disorder or injury or Diagnostic and screening procedures.

Our view is that this regulated activity will normally cover routine, planned patient transport that is related to treatment.

Sporting or other cultural events

This regulated activity will not apply if you only use a vehicle to transport a person within the boundaries of an event site or venue. As an example, if a person attending or participating in a sporting activity or event needs treatment and is carried in a vehicle from one part of the event ground to another, you do not have to register for that transport. However, if the same situation happens and the person is carried from the event ground to hospital, then you will need to register.

We will take a proportionate and reasonable approach if any emergency, unplanned treatment in this context includes some aspects of other regulated activities on an exceptional basis (such as Diagnostic and screening procedures, Surgical procedures or Maternity and midwifery services). We will also take a proportionate and reasonable approach if, in exceptional circumstances, a provider transports a patient outside an event ground and would not normally consider or plan to do this.

Other regulated activities you may need to register for

Some ambulance service providers may also need to register for the regulated activity of Treatment of disease, disorder or injury. For example, where they employ healthcare professionals and usually carry out treatment.

Where procedures are carried out, such as emergency tracheotomy, insertion of a chest drain or intubation, for registration purposes these would be considered as Treatment of disease, disorder or injury – not as the regulated activity of Surgical procedures.

Where procedures that require specialist surgical training and equipment are an expected part of the service, for example thoracotomy or amputation, we regard these as constituting the regulated activity of Surgical procedures. Therefore, if you expect to carry out such procedures and are equipped to do so you must register for that activity. However, if you carry out emergency procedures unexpectedly, we would take a proportionate view in considering whether this is regulated activity and needs to be registered.

When you register for this activity you will not have to additionally register for the regulated activity of Diagnostics and screening procedures if you only carry out the following diagnostic procedures along with transport:

• electrocardiogram (ECG)
• use of an automated external defibrillator (AED)
• pulse oximetry
• use of a sphygmomanometer
• analysis of urine or stool samples using a dip stick or other reagent
• taking blood, urine samples or swab specimens.

Medical advice provided remotely

This regulated activity applies where medical advice is:

• provided remotely, over the telephone or by email, and
• required in cases that need immediate attention or action, or triage (as opposed to a service where a person submits questions electronically to a provider who responds at a later time, or when a person seeks general health care or lifestyle advice), and
• provided by a body established for that purpose (as opposed to remote consultation and advice by a GP practice or the occasional provision of remote advice by a body such as a hospital or university on an informal basis).

This includes NHS 111 and any other organisation established to provide telephone or internet-based medical advice where immediate action or attention is needed, or that provides triage (see what this means in our glossary of terms).

Ambulance control centres are also covered by this regulated activity where they provide triage using telephony services.