The Paramedic Practitioner Programme

NHS Health Education Kent Surrey & Sussex South East Coast Ambulance Service NHS

Foundation Trust (SECAmb NHSFT)

The Paramedic Practitioner Programme 1

• Innovative Scheme• Degree course• Paramedics who are recruited who have 5yrs+ in

the ambulance service• Aim to share with Paramedics the skills of

Primary Care• Prevent unnecessary admissions• Provide an integrated service which can be taken

to patients in their home

The Paramedic Practitioner Programme 2

• Working towards co-ordinated care with community services

• Competency based Curriculum

• Based on clinical knowledge and skills development

• For selected Paramedics- a 14 month pathway

• Devised by SECAmb following review of ECP (Emergency Care Practitioner) programme, currently taught at St George’s

• Congruence with DoH NHS strategy

The Paramedic Practitioner Programme3

• Programme development:– 2 year workplace based programme pilot– Roll out in KSS GP Training Practices– Evaluation

• Collaborative development of Curriculum document

• Recruitment and implementation– Current ‘experienced’ Paramedics– Future career pathway for graduate Paramedics

The GP Placement Content1

• Acute presentations in GP in Primary Care: – working in different environments– clinical assessment, management, – communication, continuity of care– wide spectrum of presentations

• Consulting skills: – GP models vs traditional medical model

• Clinical examination skills: – beyond traditional paramedic training

The GP Placement Content2

• Treatment skills: – suturing, minor abscess drainage, – appropriate medicine management using

Clinical Management Plans (CMP)s & Patient GroupDirectives (PGD)s,

– ‘The paramedic as the drug’ (after Balint)• Team-working in primary care teams• Familiarisation with GP IT systems• Introduction of the Generalist Role

Teaching and learning• Time table for 2 months• 37.5 hr week (vaiable)• Induction to whole team, building relationships,

understanding roles.• Tutorial weekly (link with case based

discussions), time for assessments• Needs assessment• Staged progression as with GP STs, initial

observation/joint/independent practice

Evidence basedClinical Management Plans

Patient Group Directionsfor any treatments in

these plans

Clinical Management Planfor

Gastroenteritis

CMPs are developed byParamedics + GPs.Approved through SECAmb NHSFTgovernance processes

Inter-professional model of Learning and Teaching

Curriculum

Evaluation:Mutual

Stakeholder

Assessment:Gatheringevidence

Tutorialsystem

Apprenticeshipmodel

Experiential:Lots ofpatients

Learner centred

Assessment of the PP in GPCollecting the evidence

Using the tools of theWorkplace Based Assessments:

• Case-based Discussion • Consultation Observation Tool • Multi-Source Feedback• Patient Satisfaction Questionnaire • Clinical Evaluation Exercise (Mini-

CEX) • Clinical Supervisors Report

Curriculum Development

The Paramedic Practitioner Curriculum Framework, Rationale andCompetences Document

South East Coast Ambulance Service NHS Foundation Trust. (SECAmb NHSFT)

St Georges University of London and Kingston University

South East Coast NHS Strategic HealthAuthority

Health Education Kent Surrey and Sussex

PCTs Surrey, Sussex and Kent,

Royal College of General Practitioners

Patient Representation

Nature of physical

Assessment

Clinical Decision Making

Pharmacology and

Therapeutics

Completed prior to joining GP surgeryTotal 20 weeks 45 academic points Pass required to enter next stage

GP Practice Placement including final assessments

8 weeks (26 days backfill) 7 days per week rota

GP surgery Mon to FridayWIC Saturday and Sunday

Minor Injuries

Operational Consolidation

GP Practice Placement

Minor Illness

Walk in / Urgent Care Centre

Timed as required waiting to return to GP practice (extracted 36 days)

Paediatrics Elderly Psychiatry

Working in Operations extracted 1 day week for 18 weeks

Clinical Secondment can respond to local Cat A if free.

Working in Operations Minimum 6 months Maximum 10

Return to StudyPsiam

Clinical 2 weeks

Clinical Secondment can respond to local Cat A if free.

8 weeks (26 days backfill) GP surgery Mon to Friday

HEI Module

GP Placement

Walk in Centre

Consolodation

Timeframe and extraction

Area of working

KEY

Total timeframe 120 days over 18 months(Each day 12 hours)

PARAMEDIC PRACTITONER PROGRAMME

HEKSS pilot PP placement programme

Evaluation ReportProf Annemarie Rushton

Key findings of first placements - general

• Highly successful and valued programme• Wide spectrum of patients and conditions• Competencies developed:

– Communication & consultation– Data gathering– Making differential diagnosis– Clinical management

Key findings of the first placements– PP perspective

• The style of teaching and supervision– Sound work based, experiential environment– Supervision by trained educators– Based on assessed needs and learning styles– Cemented theoretical learning > practice

• Process problems with assessment– Format– Volume – Time and inconvenience to all

Key findings of first placements – GP perspective

PP students• Motivated and self-directed• Improved on all competence areas• Are or will be autonomous practitionersBusiness issues• ‘Frontloaded’ – clinical time lost at beginning• Needed to understand before exposing ST3Happy to take further PPs

Evaluation Recommendations

• Streamlining workplace based assessments• Calibration for supervisors [ST3 & other GPs]• Clearer introduction / induction guidance• Potential benefits for hosting PP students

– Business case to training practices

• Selection / screening less appropriate PPs– Poor team-working, poor assessment skills

Where to from here?• Roll out the SECAmb NHSFT / HEKSS PP programme

– Consolidate existing GP training practice placements– Introduce new GP training practices– Continue the developmental dialogue– Involve the ST3s and other GPs

• Further the interaction / relationship between GP and PP educators

• Integrate PPs in local primary healthcare community• Nationally, open up the PP examination to other Ambulance

Trusts• Apply to join RCGP Foundation for CPD support.

Blueprint of curriculum for Exam design:•Applied knowledge test: •130 item MCP [SBA] format•Clinical test – 12 station OSCE•Workplace based assessment in GP training practices :• GP trainers and SECAmb PP tutors

Quality Assurance from St George’s Hospital Med School, RCGP, College of Paramedics•Train SECAmb PPs in test writing & examining•Standard setting [pass / fail]•Simulated patients•Conduct of examination•Statistical analysis•RCGP accreditation

SHA Steering Group agree :·‘Fit for purpose’ examination·PMETB principles ·Develop Train the PP Trainers·Seek RCGP quality assurance

PP Exam Development

PP Exam – RCGP accredited

OSCE exam [and resit] 2011MRCGP CSA centre, Croydon

• Good example of integrated care.

•Excellent opportunity for ST3 trainees to become involved in teaching and assessing.

•Excellent opportunity for Paramedic Practitioners to learn about Primary care.

Summary 1

Summary 2•A good opportunity to help our patients by giving them appropriate continuity of care in the community.

• Decrease admissions, save money for PBC groups.

•Good for the practice team to form links with Paramedics.