One of the biggest problems is that hospitals can't take the patients ambulances bring to A&E fast enough as they are already chockablock.
Sir Bruce Keogh wants to overhaul A&Es into Major Emergency Centres and Emergency Centres in an effort to ease pressure and improve care.
Struggling A&E departments are to be given a £500 million Government bailout in a bid to help relieve pressure in the coming months.
Patients are being forced to wait in ambulances outside hospitals for up to six hours because accident and emergency departments are too busy to take them, according to research.
In two of the most extreme cases, a patient in Wales was made to wait more than six hours before being admitted, while another in England was delayed for more than five hours, the BBC found.
NHS guidance recommends that patients should wait in ambulances for no longer than 15 minutes and delays of more than 30 minutes in England can lead to fines.
The figures were released to the BBC under the Freedom of Information Act after it asked all UK ambulance services for their longest waits for the 12 weeks from August to October.
Summarising his proposals, NHS Medical Director Sir Bruce Keogh broke his plan into two parts.
"The first part is to provide the very best possible services and as many services as we can close to people's home - in some cases in their home.
"The second part of the vision is that where people have very serious conditions, we ensure they are treated by clinical teams who have the best expertise and are supported by the best equipment."
Prof Sir Bruce Keogh said the proposals were about "improving outcomes" for patients.
It is about improving the outcomes for patients with very serious conditions - let me be absolutely clear, that two tier system already exists.
By serious conditions what I mean are trauma, heart attack, stroke, to name three of them.
– Professor Keogh speaking to BBC Breakfast
Ambulances already when they pick up somebody with major injuries take them to designated trauma centres, they already take people with heart attacks to specific designated heart attack centres and similarly for strokes.
We have shown that when you do that, that despite initial concerns that the additional travel time would create problems, that the outcomes for patients are significantly better.
Labour's shadow health secretary Andy Burnham welcomed the new report into improving A&E services in the NHS, but said the government's cuts to the health service had left people with no alternative but to inundate A&E units. In a statement, Mr Burnham said:
We welcome Sir Bruce Keogh’s important report and share much of his analysis, but we deplore the Government's attempt to avoid presenting it to Parliament and abdicate all responsibility for the crisis in A&E.
This Prime Minister has made it harder to get a GP appointment, closed NHS Walk-in Centres and scrapped NHS Direct leaving people with no alternative but to go to A&E.
Ambulances responding to 999 calls should become "mobile urgent treatment services, not just urgent transport services", NHS Director Sir Bruce Keogh said today.
Announcing his findings of a major review into how to ease pressure on services and improve A&E care he said ambulances could treat people inside the vehicle, instead of bringing them to hospital.
He suggested more training for paramedics so the vehicles could operate safely as urgent treatment centres, and said closer links need established between the ambulance service and GPs and community health teams.
The new NHS 111 non-emergency service, which has been beset with issues since it launched earlier in the year, would be enhanced under new proposals to ease pressure on struggling A&E units released by the medical director of the NHS today.
The idea is to treat more people at home, or at the their local primary healthcare provider and keep them out of A&E. Under the proposals:
- The non-emergency service would be enhanced to provide people with a "one stop" service over the phone - and it would be staffed by trained medical practitioners
- Medical records would be on hand so that all the right information is shared between practitioners
- Workers at 111 woudl be able to book appointments for patients at their local A&E for urgent care
- Doctors and pharmacists could provide prescriptions ready for patients to collect
A two-tier A&E should be created to ease pressure on an "emergency service at its limit", according to a major review conducted by NHS Chief Sir Bruce Keogh.
The current emergency care system within the NHS is under "intense, growing and unsustainable pressure" caused by increasing numbers of people turning to A&E, an ageing population and "confusion" over existing services.
His report calls for an overhaul of the system in England to treat more people in their own homes and keep them out of A&E.
For those that do need to go to hospital for emergency treatment, he said two types of health service options should be available, offering specialist care.
Improvements in working conditions in A&E will go ahead if recommended by NHS chiefs and not from independent research, the Government has said.
Despite a damning survey showing 62% of emergency doctors thought their job was unsustainable in its current form, the Department of Health decided to wait for Sir Bruce Keogh's report.
– A Department of Health spokesman
We know we need to do more to support emergency departments to do their important work through winter and beyond.
That is why we are investing £500 million in A&E over the next two years and we tasked Health Education England with developing plans to encourage more medical students to become A&E doctors in the future.
We have asked Professor Sir Bruce Keogh to carry out a review to look at the demands on services and how the NHS should respond. Sir Bruce is due to report and share his recommendations very shortly.