Citizens and health service professionals desire high quality NHS provision. The potential conflict arises from the understandable priority for doctors, because of genuine concern for their patients and, sadly, threats of litigation, to provide the safest service.

Against this can be the wish and need of patients to receive treatment, especially for common emergency conditions, near their homes and families.
 
Patients understand the need to travel to complicated elective surgery and for multiple injuries or burns but when they have been accustomed to receiving satisfactory emergency treatment for common conditions on their doorsteps they find it impossible to accept when these are withdrawn from their local hospitals to larger units that may be miles away.
 
Since my election in Wyre Forest this has been recognised by the government with the publication of "Keeping the NHS local – A new direction of travel" in February 2003 and by Andy Black, the health service management consultant who wrote: "If the price of moving the complex emergency to an appropriate centre of expertise is that it is accompanied by another nine or 10 patients who are not complex acute cases then another set of problems is launched" (British Medical Journal 2004; 328:178-9).
 
Quality to patient and professional alike means an excellent outcome to an episode of illness. But then there is a divergence.

Ordinary people also expect kindness, compassion, explanation and continuity of care from professionals whom they trust and they expect this to be available at the place and time of need.
 
To doctors absolute safety is paramount which may mean the withdrawal from local units to larger centres where super-specialisation and less onerous rotas lead to arguably better treatment, as well as less exhaustion and stress for themselves.

Nurses aim for more academic training to reflect their true status and increasing roles but there may be risks in this to their vital, cherished, caring and comforting image.
 
The urgent need is to find a solution. The concept of managed clinical networks could achieve this if both sides recognise the need for compromise. Networks are accepted as ways of providing speciality services that have never been provided locally everywhere such as cancer and cardiac surgery.
 
Where networks are needed desperately is in accident and emergency (A&E) services. It is unacceptable to the public to close an A&E department [and replace it with] a nurse-provided minor injuries unit (MIU). Even with excellent nurse practitioners and telemedicine links there are many common emergencies that demand medical presence.
 
A true sharing and rotation of medical and nursing staff in partnerships between MIUs and their A&E units would mean each unit functions as a part of the whole and is aware of the others' problems. Unnecessary transfers could be avoided with faster treatment for all, less wasted time for patients and ambulances and less stress on the staff of the otherwise over worked A&E department.
 
Dr Richard Taylor is Independent MP for Wyre Forest and a member of the health select committee.