In 2017, I wrote a student perspective on the Newly Qualified Paramedic (NQP) programme, and how it aimed to support the experience and retention of NQPs (Robinson, 2017). Since then, little has been done to review the effectiveness of the programme, where issues such as retention have remained an ongoing issue (NHS Improvement, 2018). Having experienced and observed colleagues undertake the NQP process, this comment reflects on concerns that the College of Paramedics, research, and policy makers should explore further in order to identify improvements for the NQP programme.
The NQP portfolio
The NHS has a national consolidation period framework for NQPs in the form of a portfolio (NHS Employers, 2017). This approach assures that NQPs continue to develop key attributes, knowledge and skills to meet the professional standards of healthcare practice (Department of Health and Social Care, 2010). The portfolio has consolidation learning outcomes (CLOs) across seven sections; these are: leadership, professionalism, clinical practice, practice-based education, continued professional development, reflective practice and wellbeing. Although these are structured, certain elements—for instance, consent and patient involvement—reappear across sections. Some examples from the portfolio include the following (NHS Employers, 2017):
An issue in this instance is that while a deep knowledge of informed consent is essential for all health professionals to evidence, the portfolio does not require separate instances to exemplify such an understanding. Currently, one piece of evidence could sufficiently apply across all of the CLO sections on consent or teamwork.
Moreover, higher education institutions already demand that student paramedics demonstrate an understanding of many of the elements within the portfolio prior to registration (Robinson, 2017). For instance, aside from practice-based education, my university cohort had to write essays on all other CLOs. Although it could be argued that the perspective of a newly registered paramedic may be different to that of a student, the NQP portfolio demands no further expansion on these foundations, and therefore ‘consolidation’ feels more of a tick-box exercise rather than a period of discovery and growth.
There is an opportunity for NHS policy makers and the College of Paramedics to review and streamline the portfolio so that CLOs are more concise and less repetitive. For instance, perhaps consent could extend beyond what was already learned at university, and encourage the NQP to identify cases that require further reflection and deeper understanding.
A further issue with the portfolio is the requirement of the NQP to evidence subjective and abstract CLOs such as:
For more subjective CLOs, the framework needs to be clearer or techniques provided for NQPs to fulfil these criteria. One solution is to survey previous NQPs in how they achieved outcomes, and enable them to give feedback on their experience of completing the portfolio.
Scope of practice
A fundamental issue with the programme is that it was primarily written for NQPs within ambulance services. Since the expansion of the paramedic role, NQPs are under no requirement to work for an ambulance service; opportunities to work in an emergency department, GP or urgent care centre, or within the private sector are available to paramedics regardless of NQP status. Roles in hospital, in particular, are recruiting paramedics to become members of staff at the same grade level (band 5) as NQPs.
Further, completion of the NQP programme is not a mandatory process beyond ambulance services. Job descriptions remain focused on experience and extended learning. For example, a module in minor injuries or years of paramedic experience, ranging from 1 year upwards, enables an individual to apply for a higher-grade role, arguably, without a need to evidence or even complete the NQP portfolio.
From this, several issues arise. Ought the portfolio be applied to all NQPs regardless of role? What happens to an individual that leaves or never completes the NQP programme should they wish to return to an ambulance service after 2 years? Are development and support strategies in place for NQPs in other roles to progress to band 6?
The formal position from the College of Paramedics (2019) is that all NQPs should work on ambulances before moving to alternative roles. However, such a stance does not account for paramedics who would prefer to work in other settings for reasons such as health, working conditions, or developing expertise in other fields. Certainly, I have observed colleagues who have felt confined to the NQP programme within the ambulance service, suffered from poor mental health, and ultimately decided to leave in favour of an alternative role, including primary care practice and emergency departments prior to completing the programme. Each has since stated a significant improvement in both their mental health and job satisfaction.
While anecdotal, this exemplifies that the NQP programme does not necessarily improve retention, and could also act as a barrier to those who may wish to leave the ambulance service prior to programme completion at the cost of their wellbeing. Nevertheless, Lord Carter highlighted that paramedics tended to return to ambulance services after a number of years (NHS Improvement, 2018). Despite this acknowledgment, it is unclear how ambulance services would approach paramedics who never completed the NQP process, yet who have years of experience in different settings other than on a case-by-case basis.
Indeed, these latter points emphasise the vagueness of what differentiates a newly qualified paramedic from a ‘band 6’ paramedic. To date, there is no formal statement from the College of Paramedics on the difference. NHS Employers offers the greatest clarity between the two roles, whereby a band 6 is considered beyond an ambulance role, is a mentor and leader, and can evidence sufficient experience or completion of the NQP portfolio (NHS Employers, 2020).
As aforementioned, roles are available to NQPs (and paramedics) beyond ambulances, and therefore NHS trusts are either overlooking the advice of NHS Employers, or there remains some confusion around the paramedic role owing to a lack of unanimous structure from professional bodies and policy makers. Currently, it appears entirely plausible to circumvent the NQP portfolio in favour of gaining sufficient experience elsewhere. I would argue that this leaves NQPs in non-ambulance roles lacking in structured support and development, and that the existing NQP portfolio and programme do not account for this.
Thus, institutions, particularly the College of Paramedics, need to provide a formal statement on whether to diversify the programme so that it either incorporates or limits NQPs in non-ambulance roles. Furthermore, research should explore the views of NQPs and those who have recently progressed to band 6 to assess the retention, wellbeing, and effectiveness of the programme.
On a final note, my experience of the programme has been largely positive, where the portfolio has provided a structured approach in evidencing the pathway to band 6. In comparison to other healthcare professions, the 5-year journey from student is short, and will build a solid foundation for my practice and future career. I hope the majority of other NQPs feel the same way. Yet, as discussed, it might not be appropriate for everyone, and I would urge those for whom it isn't, to speak up and encourage both policy makers and the College of Paramedics to review the programme and make appropriate changes.