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People in Buckingham and Milton Keynes are facing some of the longest waits for an Ambulance in England.
But England's Chief Inspector of Hospitals has rated South Central Ambulance Service NHS Foundation Trust as Good following an inspection by the Care Quality Commission.
Overall the trust's emergency operations centre, patient transport and NHS111 service were rated Good - although the emergency and urgent care services were rated Requires Improvement.
Full reports have been published on CQC's website http://www.cqc.org.uk/provider/RYE
In the report highlights the trust's work with partners in the NHS to transform care delivery and improve outcomes for patients... including the use of smartphones for assessing patients remotely, end of life care to support patients in their own homes, and improved access to pharmacists.
Prof Edward Baker, Deputy Chief Inspector of Hospitals in CQC's South region, said:
"Well over 4 million people rely on South Central Ambulance Service to be there when they need them. The trust has a clear vision to co-ordinate its services so that people receive the right care at the right time - including care closer to home.
It is to the trust's credit that it performs above the England average for the number of patients managed without need for transport to hospital. Many services are being introduced to manage demand, avoid hospital admissions and refer patients to alternative non-urgent pathways of care.
While we found that staff were proud to work for the organisation, there were pressures on the service which were affecting staff morale. The trust is affected by the national shortage of paramedics, and many staff have been working long hours, some without breaks. Through no fault of the ambulance services, its vehicles are often facing prolonged delays at some acute hospitals' emergency departments. For people needing an urgent response, the consequences can be serious.
Our inspectors have found that some areas where improvements are needed. At the time of our inspection the average time to respond to emergency calls was worse than the national average and the trust had some of the longest call waiting times, of over 3 seconds over the national average. We will continue to monitor the trust's performance and we will return at a later date to check on progress."
Across the trust, the inspection team found several areas of outstanding practice including:
* A smartphone triage app had been produced in conjunction with the Wessex Trauma Network. This meant clinicians could use the triage tool to identify if their patient needed to bypass a local hospital and be conveyed directly to a major trauma centre, and which one was the closest
* The trust had introduced specialist paramedics to support patients to manage their own health conditions at home without the need for hospital admission
* The trust uses a mobile simulation vehicle which offers an innovative approach to training for staff
* Mental Health practitioners are in control contact centres at weekend peak times. They are piloting direct referrals to Samaritans and local mental health teams. This has improved timely patient access to mental health services
* The NHS 111 provider had worked collaboratively with Age UK to develop a "Sense of Ageing" course for all staff in order to raise awareness of the needs of older patients. This course was being shared nationally as an example of good practice
* The trust was working in partnership with a university in Poland to support the recruitment of paramedics. The university taught students in English to aid employment in the UK and the trust had also supported the integration of Polish staff into the community
* The inspection team also saw several areas where improvements must be made, including:
* Staff in urgent and emergency care must be supported with their development through supervision
* Response times for emergency and urgent care services must be met
* Governance arrangements in emergency and urgent care services must ensure that staff are aware of risks and safe practices are consistently applied
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