Paramedics

 

We are currently developing this page to include education, training and other useful resources to support paramedics within Primary Care.   

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What is a Paramedic?

Paramedics are autonomous Allied Health Professionals (AHPs) who have traditionally been employed by NHS ambulance services (84% in 2012). They are trained in all aspects of prehospital emergency care, ranging from acute problems such as cardiac arrest, strokes, spinal injuries and major trauma, to urgent problems such as minor illness and injury.

In recent years, the paramedic profession has evolved from being a provider of treatment and transportation to a provider of mobile healthcare. As a result of this evolution, paramedics can now be found working in multiple settings including general practice, minor injury units, urgent care centres, walk-in centres and accident and emergency (A&E) departments, telehealth, and telecare services and in the armed forces and remote and offshore sectors. Paramedics undertake full clinical assessments and make decisions regarding the care provided to patients. Changing demands have required the paramedic workforce to be flexible, to develop the skills and competencies required to treat and manage increasingly complex patients, while continuing to provide excellent and safe patient care. However, the development of these roles has not occurred consistently, with a variety of different programmes, job titles and scopes of practice for paramedics working in these areas.

What do Paramedics do?

Paramedics working in primary and urgent care can undertake a variety of roles including:

• competently use the medical/biopsychosocial model to assess, examine, treat and manage patients of all age ranges with a variety of acute undifferentiated and chronic conditions
   
• triage patients, carry out telephone consultations, undertake face-to-face consultations, carry out home visits (including residential and nursing homes)
   
• request, review, and act on laboratory results
   
• paramedics can refer to specialist services or certain investigations as appropriate
   
• paramedics can see patients presenting with acute or urgent (same-day) problems, as well as offering pre-booked and routine appointments
   
• paramedics are also able to mentor and supervise students from a range of health and social care backgrounds.

The level of competence at which the paramedic in primary and urgent care can work will depend on their skills and experience, and the skills and experience of the practice team. Paramedics in primary and urgent care should be aware of their level of clinical competency, and their areas for development, working within their limits and scope of practice. As each general practice and urgent care provider is run differently, a paramedic’s role in primary and urgent care may differ across each practice or urgent care setting.

NHS England have co-published guidance which describes the scope of practice of paramedics working in general practice.   It includes information on education/development needs, supervision requirements and the differences between enhanced, first contact and advanced levels of practice.

NHS England also commissioned the development of the Paramedic (Specialist in Primary and Urgent Care) core capabilities framework to support those paramedics working in primary and urgent care and the transformation of services that employ these clinicians in new environments. The capabilities set out what a paramedic can do, recognising that the paramedic working in primary and urgent care must be adaptable and not constrained by protocols or prescriptions for practice. The framework describes the knowledge, skills and behaviours that must be acquired, developed and demonstrated in order to safely and effectively manage service users across the lifespan and in often quite challenging conditions.

What training and qualifications do paramedics have?

To practice as a paramedic, an approved degree in paramedic science is required or an equivalent apprenticeship degree. Application to an ambulance service as a qualified paramedic and registration with the Health and Care Professions Council (HCPC) is then required. Regulations as with all other allied health professions, the term ‘paramedic’ is a protected title by law. All paramedics, whether working in the NHS, private or voluntary sectors must be registered with the Health and Care Professions Council (HCPC). To remain on the HCPC register, registrants must demonstrate that they continue to meet these standards as this is how their fitness to practice is determined. All paramedics are required to renew their registration with the HCPC every two years, to continue to practice as a paramedic.
As registered health professionals, there are also expectations for paramedics to undertake activities relating to leadership and management, and research and education (which include the role of a practice educator).
Paramedic science courses usually take between three or four years full time and include a mixture of theory and practical work including placements with the ambulance services.

Entry requirements for an undergraduate course are typically:

• two or three A levels, including a science, along with five GCSEs (grades 9-4/A-C), including English language, maths and science

or equivalent qualifications:

• a BTEC, HND or HNC, including science
• a relevant NVQ
• a science- or health-based access course
• equivalent Scottish or Irish qualifications.

Additional training and qualification information:

From the 1st of April 2018 paramedics working at an advanced level of clinical practice could become independent prescribers. Paramedics are annotated on the HCPC register as an independent prescriber after successful completion of an HCPC-approved independent prescribing programme.
From 2021, all paramedics wishing to enter the HCPC register must have a BSc (Hons). The career framework outlines that paramedics working in specialist and advanced practice roles should be educated to post-graduate diploma and master’s degree level, respectively. However, the professional shift into higher education has only occurred within the last decade and many paramedics who are currently employed in specialist or advanced roles within primary, urgent, emergency, and secondary care may not have these qualifications.

It is expected that paramedics will have successfully completed a preceptorship programme (or similar) prior to working in primary or secondary care. This preceptorship period is often completed in the first two years after initial registration; an example of this scheme is the Newly Qualified Paramedic (NQP) programme. Such programmes are usually only offered within frontline ambulance services and are like the foundation years of medicine. It is recognised that during this period, a newly qualified paramedic would be expected to discuss referral and discharge decisions with a senior clinician. Now and in the future, completion of a preceptorship programme aims to ensure a well-rounded, general paramedic, with experience in the assessment and management of a wide variety of patients across the clinical and social spectrum.
Paramedics work at various levels of clinical practice (from newly qualified to consultant), so when employing a paramedic in primary or secondary care, employers need to be clear about the scope of practice that the paramedic will be expected to work within to ensure applicants possess the correct skills and knowledge to undertake the role.

Paramedics new to primary and urgent care will also be able to see the range of patients that present to general practice and urgent care settings but will initially need more supervision and support. The level of supervision and support will lessen as the paramedic grows in confidence, knowledge, skills and experience, but a good foundation of support is vital to ensure their safety in this new practice setting. Specialist and advanced paramedics working in primary and urgent care have greater depth of knowledge and understanding, usually gained through completion of post-graduate education. They may receive education and training in a range of specialist and advanced clinical skills. Some of this will form part of a course of post-graduate education to prepare the paramedic to work in primary, urgent, emergency, and secondary care, or may be developed with mutual agreement between the paramedic and a clinical supervisor during time in clinical practice. An employer wishing to develop a paramedic in specialist and advanced skills should ensure the paramedic receives education from a provider who is qualified and competent in that skill, including supervised practice, as well as completion of a portfolio of work.

Salary

Salaries are covered by the NHS Agenda for Change pay scales. Paramedic salaries start at band 5, which ranges from £24,907 to £30,615. After two years following a newly qualified paramedic pathway the next band is a band 6 (£31,365 and £38,890).

For team leaders or senior paramedics who have undertaken extended skills training in critical care or trauma, salaries are at Band 6/7 and fall between £31,365 and £44,503. Paramedics working in primary care or in a GP practice should expect to gain band 7 after a year.

A consultant paramedic will achieve a Band 8c salary of £63,751 to £73,664.

 

Roadmap for Paramedics wanting to work in Primary Care

NHS England has developed a new pathway to help paramedics advance their careers. The ‘roadmap to practice’ outlines the skills and attributes needed to help paramedics become first contact practitioners (FCPs) or advanced practitioners (APs).

Clinicians completing the capability framework will be recognised by NHS England’s Centre for Advancing Practice and will be placed on a First Contact Practitioner directory.

The new roadmap provides a clear educational pathway for paramedics who wish to work in primary care, as well as setting out the supervision and governance needed and giving training guidance for supervisors.

It clearly articulates the capabilities so that employers and workforce planners can understand what the clinicians can offer to the multi-professional team to enable the best care for their patient population. It also provides clear guidance of the expected supervision needed to support the roadmap to practice and outlines the bespoke supervision training that a supervisor needs to have completed.
It is expected that all clinicians applying for roles in primary care will have completed training and have been recognised by our Centre for Advancing Practice prior to job interview by April 2022.

From April 2021 clinicians should have started either the portfolio route of have started an FCP HEI level 7 module to prospectively and retrospectively to meet this deadline.

By providing a standard of practice there is a solid governance structure around First Contact roles and advanced practice in primary care. This ensures gold standard care and puts our patient’s safety first.