Our work includes:
We have been looking at how we can enable specialist and advanced level paramedics to develop their skills, so they are able to work effectively across a number of settings. We are investing £600,000 to trial a new working model for specialist and advanced paramedics, deploying them in rotation across a variety of settings - including primary and community-based care, as well as within the ambulance service. The pilot is expected to improve patient care and relieve workload pressures.
The pilots, that will run in collaboration with Yorkshire, North East, East Midlands and South Central Ambulance services, will explore whether a new rotational model of working is feasible and economically viable. Specialist and advanced paramedic practitioners will work in Emergency Operations Centres within the ambulance service; community-based multi-disciplinary teams; and GP practices, on a rotational basis.
HEE have led a major piece of work since January 2014 stemming from the Paramedic Evidence Based Education Project (PEEP), which recommended the introduction of a single point of education entry at degree level for paramedic training. This work is being carried out in partnership with the college of paramedics and with support from the Association of Ambulance Chief Executives and we are working to ensure this becomes a four nation initiative.
The Paramedic Education and Training Steering Group was established to review the potential benefits of upskilling and training paramedics to enable them to deliver more treatment in the community, as well as better deliver on-site triage and treatment in emergencies, where clinically appropriate.
The Steering Group meets regularly and is co-chaired by Patrick Mitchell, Director of National Programmes at HEE and Professor Andy Newton, Chair of the College of Paramedics. The Steering Group has expressed its support for:
- a standardised approach to all aspects of education and training for paramedics
- an agreed standards of proficiency and standards of education and training together with the College of Paramedics curricula guidance and competency framework will be submitted for independent review to confirm the standards of education at BSc level
- a review of the College of Paramedics scope of practice and HCPC standards of proficiency
- paramedic registration to be at BSc level for new registrants through a phased approach
- education and development opportunities for the existing workforce should be considered and a transition plan formed and
- organisations to have mentoring and preceptorship arrangements in place consistent with the curricula requirement.
The initial recommendations have been agreed by the Steering Group and will now be taken forward for further engagement and the development of local delivery plans, before finally being considered by HEE’s public board.
We have also made a significant investment in paramedic training – a 87% increase in new starts to paramedic training over two years, providing for 1,902FTE growth in available supply over the next five years - and will work with ambulance leaders and wider system partners to discuss our data and agree action to ensure sufficient supply in advance of our new trainees qualifying.
As part of its work to enhance the learning environment for the student paramedic across the whole health and social care system, HEE is investing in a pilot for a pre-degree experience placement for paramedics.
The pilot will assess whether a period as an ambulance support worker can help students develop care, compassion and resilience values and skills before they embark on their degree and career as a paramedic, and are able to provide high quality care to patients of the future. If implemented the pre-degree placement could for the first time standardise how ambulance trusts recruit their ‘in-house’ trained workforce, enabling potential student paramedics to work within an ambulance trust to gain paid experience before applying for their degree.
We are piloting a new working model for specialist and advanced paramedics, enabling them to rotate through a variety of settings as one role - including primary care and community-based teams as well as within the ambulance service. The pilot is expected to improve patient care and support workload for each organisation involved.
The role of the paramedic has developed over recent years to meet the move towards supporting patients to be treated and managed within their own home. As a result, new roles for paramedics working in primary and urgent care settings are being developed, either via direct employment or via paramedics on rotation from the ambulance service.
The paramedic workforce needs to be flexible to changing demands. Paramedics need to develop the skills and competencies required to treat and manage increasingly complex patients, while continuing to provide excellent and safe patient care. The Paramedic Specialist in Primary and Urgent Care Core Capabilities Framework describes, in a clear and consistent manner, the necessary scope of practice for a paramedic specialist to be able to work effectively across primary and urgent care to the benefit of patients and the community.
- enables commissioners of services to specify minimum standards for clinical employment/placement of paramedic specialists.
- enables managers to demonstrate that paramedic specialists working in primary and urgent care meet core capabilities or have developmental plans in place and clinical supervision to meet the nationally recognised framework.
- helps education and training providers to focus on the key capabilities that learners need to achieve, which in turn will guide the content to be included and the use of appropriate learning and teaching strategies.
- sets out clear expectations for practitioners about the requirements of effective and safe extended practice roles and transferable skills.
- can be used by service users and the public to understand the expectations of the paramedic workforce in primary and urgent care and to plan effectively for their own current and future care.
The findings of the first Impact of COVID 19 study in 2020 indicated that paramedic students were feeling anxious and less confident to enter the workforce.
This project looked at anxiety and confidence in clinical decision making in student and newly qualified paramedics using a modified version of a clinical confidence tool for nursing, alongside a two-staged review of the paramedic preceptorship programme within South Western Ambulance Service Foundation Trust (SWASFT). The project was co-produced between Health Education England team in the South West, and SWASFT. Recommendations were co-produced with the University of Gloucestershire paramedic pre-registration students, SWASFT newly qualified paramedics involved in the project and the SWASFT Preceptorship task and finish group.
- Pilot a clinical confidence tool with final year student and newly qualified paramedics to ascertain if it provides a useful self-assessment tool to support understanding of the factors that affect confidence and anxiety in clinical decision making
- Establish levels of anxiety and self-confidence in clinical decision making in final year student paramedics due to graduate in Dec 2021, and newly qualified paramedics six – twelve months into their first year as a registrant
- Propose recommendations regarding strengthening the Flaky Bridge for student and newly qualified paramedics, identifying potential opportunities to improve early clinical career support focussing on learning opportunities, placement and preceptorship programmes in relation to clinical decision making
- Critically review the current preceptorship model used within SWASFT and readiness to support new registrants joining the ambulance service from September 2021.
- Student and newly qualified paramedics are experiencing normal and expected feelings and experiences around transitioning from student to newly qualified and newly qualified to autonomous practitioner, mirroring the existing evidence base regarding ‘transition shock’
- Repeat exposure, practice and rehearsal in clinical decision making is helpful for student learners and staff new to role
- Creating psychosocial safety within environments and cultures that address anxiety and promote self confidence to make clinical decisions is paramount to support confidence building
- Preceptorship can help to reduce anxiety and increase confidence in clinical decision making for those new to role.
Work is ongoing regarding implementation of project recommendations at undergraduate level and during the preceptorship period during 2021/22 by our team int he South West. Read our full report - Understanding anxiety and self-confidence in clinical decision making.