The service and its context With difficulties being experienced in the NHS through staff shortages in medical specialities, changes in primary care service delivery and increasing expectations of the public, the pressures on Accident and Emergency (A&E) departments have never been greater. Doctors, and therefore medical skills, are in particularly short supply. This chapter reports on a study designed to meet the skill deficit and the public's need for a safe, efficient and effective A&E service by provision of specially trained nurses as the first point of contact. The study was funded by the NHS West Midlands Research and Development Directorate, and was completed in June 1998 (Bamford et al., 1998).