Paramedic

Overview

Paramedics have been transitioning into enhanced and advanced practice roles within General Practice for several years. Increased pressure and demand on primary care services have been a catalyst for more opportunities for Paramedics to work in this environment.

Within Suffolk and North East Essex, Paramedics are an already established workforce in General Practice and are increasingly supporting PCN’s to change their care models to best treat their patients. The models are varied, but mainly include carrying out home visits and seeing acutely unwell patients.

“Paramedics have so many complementary skills and in primary care there are many areas where paramedics can compliment the rest of the primary care team, not least acute care, but also, domiciliary visiting and follow up the same day that may well enable patients to stay in their own homes rather than being sent to hospital…”
Professor Simon Gregory, Health Education England

Scope of Practice

Role Responsibilities:

Where a PCN employs or engages a Paramedic under the Additional Roles Reimbursement Scheme, the PCN must ensure that the paramedic:

Is educated to degree/diploma level in Paramedicine or equivalent experience,
Is a registered Paramedic with the HCPC,
Has completed their two-year ‘Consolidation of Learning’ period as a “newly qualified paramedic”,
Has a further three years’ experience as a band 6 (or equivalent) paramedic,
Is working towards developing masters level or equivalent capability in paramedic areas of practice and, within six months of the commencement of reimbursement for that individual (or a longer time period as agreed with the commissioner), has completed and been signed off formally within the clinical pillar competencies of the paramedic FCP/AP roadmap to practice,
Works as part of a MDT within the PCN,
Assess and triage patients, including same day triage, and as appropriate provide definitive treatment (including prescribing medications following policy, patient group directives, NICE (national) and local clinical guidelines and local care pathways) or make necessary referrals to other members of the primary care team,
Advise patients on general healthcare and promote self-management where appropriate, including signposting patients to the PCN’s social prescribing service, and where appropriate, other community or voluntary services.

A Paramedic must be able to:

Perform investigatory procedures as required,
Undertake the collection of pathological specimens including intravenous blood samples, swabs, and other samples within their scope of practice, and within line of local and national guidance,
Support the delivery of ‘anticipatory care plans’ and lead certain community services (e.g. monitoring blood pressure and diabetes risk of patients living in sheltered housing),
Provide an alternative model to urgent and same day GP home visit for the network and clinical audits,
Communicate at all levels across organisations ensuring that an effective, person-centred service is delivered,
Communicate proactively and effectively with all colleagues across the multi-disciplinary team, attending and contributing to meetings as required,
Maintain accurate and contemporaneous health records appropriate to the consultation, ensuring accurate completion of all necessary documentation associated with patient health care and registration with the practice,
Communicate effectively with patients, and where appropriate family members and their carers, where applicable, complex and sensitive information regarding their physical health needs, results, findings, and treatment choices.

Entry Requirements

To have successfully completed an approved qualification in paramedic science – The College of Paramedics (CoP) states that, from 2021 onward, all paramedics should have a BSc (Hons).
Must be registered with the Health and Care Professions Council (HCPC).
Five years post registration

Training and development

Standard Training (on entry to primary care)

If a paramedic is employed under ARRS, they will need to complete stage 1 & 2 of the First Contact Practitioner (FCP) Roadmap as outlined by NHS England (NHSE), within the first 12-18 months of commencing the role.

First Contact Practitioner Recognition:

FCP roles began with the development of the FCP Physiotherapist in 2014, in response to the shortage of GPs in Primary Care. FCP roles are designed to support GPs as part of an integrated care team and to optimise the patient care pathway by seeing the right person in the right place at the right time.

To create sustainability for multi-professional FCP roles, there is a need to build a clear national Primary Care training pathway for clinicians moving into FCP roles and then onto Advanced Practitioner roles. Therefore the NHSE ‘Roadmaps to Practice’ were published to support educational pathways for clinicians

Please find below links to significant documents which will help service providers, managers and Paramedics themselves to identify what training, qualifications and competencies they should have to safely and effectively practice at first contact practitioner levels.

First Contact Practitioners and Advanced Practitioners in Primary Care: (Paramedics) A Roadmap to Practice (hee.nhs.uk)

Musculoskeletal (2018) | Skills for Health

Paramedic Specialist in Primary and Urgent Care Core Capabilities Framework.pdf (hee.nhs.uk)

Working alongside the ‘First Contact Practitioners AND Advanced Practitioners in Primary care (Paramedic); Roadmap to practice (link above), FCPs must have completed both stage 1 and Stage 2 of the Roadmap to gain recognised First Contact Practitioner MSK status.

The Paramedic can be seen as a ‘trainee FCP’ until full FCP recognition is gained.
At present there are 2 main educational pathways by which one can train to be a First Contact Paramedic;

Via an FCP portfolio completely
Via portfolio with taught routes via HEI’s.

There are two stages to First Contract Practitioner recognition

Stage 1: Preferably, must be completed with a portfolio of evidence and verified before employment in Primary Care. The KSA must be completed prior to employment as a FCP or AP in Primary Care to assure patient safety. For clinicians already working in primary care this can be completed retrospectively.

Stage 2: Is completed with a portfolio of evidence and verified in Primary Care. This is the recognition process of the application of the KSA in Stage 1 to clinical practice in Primary Care. Best practice is that this should be completed within 6 – 12 months for a full-time member of staff but this can be longer provided a completion date is agreed with the employer.

‘Trainee’ FCP’s are advised to keep a folder of evidence ready to submit in the final stages of their pathway.

Education providers

There are education providers across the UK that are successfully running Paramedic FCP taught modules. NHSE has also provided funding support for applicants to attend these modules. All the providers have committed to taking learners from outside the region that they are based.

Please see information and links below to each provider for further information. If you are looking to enquire about an FCP taught module, please contact the education provider directly to discuss your individual requirements.

Additional Training Opportunities

As paramedics progress along their educational pathway, their scope of practice within the general practice teams will advance, and this can be further enhanced through the completion of additional training.

Advanced Practice Recognition

Please see link to the SNEE TH Advanced Practice page for full information on Advanced Practice

Supervision requirements

Supervision is a process of professional learning and development that enables individuals to reflect on and develop their knowledge, skills and competence, through regular support from another professional.

Supervision can have different forms and functions and a number of terms are used to describe these. For this guidance we use the below terms and define them as follows:

Clinic/practice supervision: day-to-day support provided by a named/duty senior/more experienced clinician for issues arising in the practice.
Clinical/professional supervision: regular support from a named senior/experienced clinician/practitioner to promote high clinical standards and develop professional expertise.
Educational supervision: supports learning and enables learners to achieve proficiency.

It is recommended that Paramedics have access to appropriate clinical supervision and an appropriate named individual in the PCN to provide general advice and support on a day-to-day basis. This would typically be more senior/experienced paramedic but may be another registered health care professional as appropriate. Recommended minimum frequency of a 1 hour supervision meeting is monthly. Whilst an FCP trainee, it is recommended that daily debriefs/reflection time is also supported.

Supervision Guidance for primary care network multidisciplinary teams (NHSE, 2023)

Clinical and Education supervisors have an integral role to support learners through the FCP Recognition process and to provide assurance that the practitioner has demonstrated the knowledge, skills and attributes required to work in a FCP role in primary care. One of their key roles is to review a learner’s portfolio of evidence and decide whether the individual has met the requirements of an appropriate FCP Roadmap.

For both the FCP Supported Portfolio and FCP Taught routes, Clinical and Education supervisors will work with an education provider, as part of the institution’s quality assurance processes, to support the learner to meet the appropriate level 7 learning outcomes of the applicable FCP Roadmap. Supervisors will sign-off the portfolio of evidence on successful completion.

The route to becoming a supervisor for FCP recognition and training has recently been updated. Please see the NHSE ‘First Contact Practice FAQ’s’ page here for the latest updates on the process.

For further information please see the NHSE Roadmap landing page.

Funding

AFC Band 7/8a

100% of actual salary plus defined on costs covered via ARRS Scheme.

Training and Development Funding

Paramedics may be entitled to wider NHSE commissioned funding to support their training and development requirements. Please contact the training hub for more information on this.

Recruitment Information

Where a PCN employs or engages a Paramedic under the Additional Roles Reimbursement Scheme, the PCN must ensure that the Paramedic meets the ‘Minimum Role Requirements’ stipulated in Annex B of the Network DES

Please find various resources in this section to assist in the recruitment and embedding of theParamedic role in General Practice.