The Health and Care Professions Council (HCPC), formerly known as The Council for Professions Supplementary to Medicine (CPSM), describes itself as a regulator, set up in response to a piece of legislation called the Health Professions Order 2001, with a specific remit to protect the public by registering health and care professionals and ensuring they meet the standards for their training, professional skills, behaviour and health (HCPC, 2013).
However, despite this remit, it remains questionable as to whether the training, skills, and behaviour of the HCPC itself is adequately ensuring the health of the general public, and inhibiting future progression of the paramedic profession.
The labour intensive, under-qualified, transportation perceptions once attributed to ‘ambulance drivers’ and now paramedics, have been shaken off to an extent in recent decades, resulting from rapid change in training, education, professional representation and importantly, registration.
Chung (2001) stated that although emergency medicine is a young and developing speciality, recognised only as such in around 10 countries worldwide, it is rapidly expanding in different directions and has broken the proverbial walls of hospitals to represent itself independently. This was seen none more so than in the mid 1990s, when many paramedics themselves aspired to develop their role into a profession, and for them individually to embrace the notion of becoming a professional (Donaghy, 2008); but one questions what this actually meant for future practice.
‘Medical education, evidence-based care, accountability and professionalism are all factors catalysing the modernisation and professionalisation of modern British paramedicine’
Abbott and Meerabeau (1998) explain that the status of professions dates back to the medieval age and the establishment of the then three great professions of law, divinity and medicine. They further explain that professions distinguished themselves from the ‘occupations’ by possessing three major traits, later defined as ‘Trait Theory’. These traits consisted of an elite education, an exclusive body of expert knowledge, and autonomous self-regulation. As a result, professions were elevated above ‘occupations’, giving them an advantageous monopoly in the labour market.
With the introduction of university education for paramedics and the inauguration of the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) in the early 1990s, and the British Paramedic Association (now the College of Paramedics) to follow some time later, these professional traits were certainly beginning to be seen within paramedicine. However, they have arguably been greatly diminished and certainly inhibited by some of the continually complex, conflated and convoluted behaviours of the HCPC towards its paramedic registrants.
Gayle (2011) describes the HCPC role as setting standards, approving pre-registration courses, keeping a professional register, and taking action against registrants who fall below the required standards. These are roles that are not dissimilar to the Nursing Midwifery Council (NMC) and the General Medical Council (GMC), although ones for which much professional dissidence is felt.
The HCPC standards of proficiency (2012) describe paramedic practitioners as being autonomous, a concept which encourages and is built upon the act of independence and/or having the freedom to do as one pleases for the benefit of themselves, or in this context, their patients. However, this autonomy is simultaneously entirely discouraged by the negative and often punitive emphasis placed upon deviation from guidelines in fitness to practice hearings, formed by the JRCALC, whose role it is to provide robust clinical speciality advice to ambulance services (JRCALC, 2009).
It would appear that the guidance for paramedics given only in an advisory capacity by JRCALC is overshadowing the increasing level of self and university education, experience, professional development, increasing knowledge, and potential autonomy of today’s paramedics, through its often castigatory use by the HCPC as some from a restrictive statute. A process that one continues to argue is only incubated by some ambulance service middle managers who themselves have similarly narrow and professionally limiting views as the HCPC. Complexities that are perhaps best exemplified by the scope of practice of advanced emergency care practitioners, almost all of which is outside JRCALC advice, yet they remain under HCPC paramedic registration.
The potential benefits that emergency and unscheduled care patients may see by more confident, professionally outgoing, and assertive paramedics using knowledge and skills they already possess or are working towards possessing, are being stifled by sensitive perceptions that any deviation, which is often actually also progression, would be readily punished. This arguably provides limited and highly regressive protection of the public, contradictory to HCPC aims.
Healy (2012) asks ‘since when has our hard-earned professional registration become a threat to be used against us so routinely?’ Speaking from a nursing perspective and highlighting problems in other professions, Healy describes the constant thought and mention of deregistration as an insidious form of bullying that only serves to undermine a profession and add to the culture of fear and blame now pervading so much of the NHS; and one that views mistakes as purely negative occurrences and not potential opportunities.
Brady (2013) suggests this may indeed also be the case to an extent with the HCPC, who in an attempt to protect the public may not view or use practitioner mistakes and challenges as opportunities for individual and professional improvement and development. Instead, they may actually prevent practitioners becoming more learned, reflective and experienced, as seen within general medicine, and thus not promoting public protection at all.
‘It is apparent that paramedics are currently not fully using their exponentially increasing knowledge and skills to their full efficiency for best patient care’
Medical education, evidence-based care, accountability and professionalism are all factors catalysing the modernisation and professionalisation of modern British paramedicine (Lateef and Nimbkar, 2005). The JRCALC is indeed—but not without argument—evidence based, and the role of the HCPC is unarguably important in protecting the general public, many of whom are vulnerable and in need of such a presence; practitioners should have to justify their decisions to themselves, their patients and to their peers. However, while paramedics are under the precipice of a seemingly external regulator viewed with such dissidence and involving itself detrimentally in ambulance service policy, practitioner autonomy, and overall progression, one unfortunately questions if, according to trait theory, paramedicine is not yet a profession at all, a view many paramedics, including himself, have worked so very hard to change. Debate is a sign of a healthy profession and one hopes to instigate discussion on this subject through literature, which will no doubt will be applicable to many health professionals.
It is apparent that paramedics are currently not fully using their exponentially increasing knowledge and skills to their full efficiency for best patient care, due to an inherently perceived risk that deviation from rigid, often very constraining and limiting guidelines, which are often deemed unarguable, will result in deregistration. Future articles will explore what is actually meant by guidelines, evidence-based care, autonomy and professional regulation, and to what extent these factors are progressing or limiting gold standard holistic unscheduled patient care and public protection.