The roll-out of a clinical leadership model is progressing well at North West Ambulance Service NHS Trust (NWAS), with the implementation of a senior paramedic tier now nearing completion. The model provides clinical staff with clear career progression, in line with the College of Paramedics career framework and is essential in providing high quality pre-hospital care services for the future.
Background
The service made its vision clear to implement a clinical leadership and supervision structure, some years ago. This process began with the introduction of a consultant paramedic and a team of 36 advanced paramedics. Their role was to focus on clinical care, quality and safety and to provide support and supervision to all frontline clinicians. The trust then developed the model further by conducting a review of clinical band six roles occupied by 256 staff members with a variety of titles; emergency care practitioner, operations supervisor, assistant operations service manager, clinical trainer, team leader and clinical practice supervisor.
Research for the review included three methods to scope out the work carried out by band six staff in addition to their ambulance response duties:
The findings of the review raised questions about how effectively these roles were being carried out due to the many aspects required of staff, some with a greater clinical bias and some with a greater bias towards logistical functions.
Other conclusions drawn from the review included the lack of strength and status to supervise operational staff groups 24 hours a day seven days a week, across a large geographical footprint, alongside meeting performance targets and keeping up with essential requirements such as infection prevention and control.
Feedback from face-to-face staff sessions clearly identifed the need for local supervision. A system where staff could identify a local leader and have access to them in their daily work was needed. The trust’s human resources strategy also set out the ethos for team working in well defned staff groups with identifed leaders.
Following the review
The review concluded that the varying clinical band six roles should be redefned to establish a consistent managerial arrangement which would offer supervision and clinical advice to operational teams consisting of paramedics, EMT2s, student paramedics and EMT1s.
It was decided that the band six staff would be split into two roles:
The role of the Assistant Operations Manager would be to work closely with the operations manager on operational and logistical issues such as carrying out personal development plans and knowledge and skills framework appraisals, addressing hospital emergency department delays, uniform replacement issues, IPC vehicle and estate issues, station fuel management, ensuring vehicle deployment in accordance with the local rota and leading team.
The role of the senior paramedic would take responsibility for all aspects of clinical quality, safety and supervision for a group of staff working closely with the advanced paramedic. Post holders would need to monitor clinical performance, adhere to clinical guidelines, ensure infection prevention and control standards are met, provide remote clinical advice to paramedics and emergency medical technicians, and to provide advanced clinical assessment of patients along with the provision of a senior clinician at serious incidents and responding to emergencies.
Future clinical vision
NWAS had also clearly stated that a fundamental aspect for the future direction was the ability for clinicians to be able to implement appropriate care pathways and, where necessary, safely discharge patients into the community or leave them with self-care advice. Clinicians would need to be able to identify appropriate patients through thorough assessment and examination and then take the correct decision to determine appropriate treatment for the patient. In order to implement this level of service, and to ensure the process was safe, a senior clinician would need to provide support and supervision. The introduction of senior paramedics supported this, and refected the overall vision of NWAS to ‘deliver the right care, in the right time, at the right place’.
Taking healthcare to the patient
The days of the ambulance driver who would pick a patient up from home and drop them off at hospital with no or little, medical intervention are long gone. The public expect a highly qualifed medical professional to deliver their care when they dial 999. However, the increased demand for ambulance services is largely driven by urgent care needs. Therefore, commissioners are increasingly looking towards ambulance trusts to help to manage this demand, resulting in a move away from a traditional response model to service models that differentiate more effectively between emergency care needs and urgent care needs. In order for NWAS to provide service models to meet the needs of the commissioners and the public, it needed to invest in education and supervision for clinicians to give them the skills to provide safe care and advice to patients. This would enable them to make local decisions about local people.
The Taking Healthcare to the Patient document recommended that ambulance services improve leadership, both clinical and managerial, so that organisation structure, culture and style could match new models of care. NWAS’s clinical leadership structure supports the trust in delivering a responsive service to those with emergency and urgent care needs.
Role and responsibilities
The purpose of the senior paramedic is to participate in the delivery of excellent patient care through the continuous review of clinical standards within agreed framework, policies, procedures and protocols. To be responsible for the clinical leadership and clinical supervision of a defned group of staff and to be committed to the development of innovative practice and expanding evidence based care, this will contribute to the enhancement of the senior and advanced emergency care role.
Senior paramedics look after staff groups from a station or groups of stations and are routinely rostered on rapid response vehicles to allow regular access to members of the team during the shift and allow the senior paramedic to fulfil the senior clinical role.
Clinical
Senior paramedics predominantly operate as a solo clinician, providing assessment and treatment utilising evidence based practice, taking the clinical lead at appropriate incidents, making specifc interventions and appropriate referrals and providing face to face and remote advice to ambulance practitioners and patients.
Management and performance
Working with advanced paramedics to ensure clinical standards are met and exceeded, senior paramedics monitor patient report forms, individual performance of clinicians and provide feedback to teams on clinical performance indicators and care bundles.
Education and mentorship
As well as gaining their own BSc in enhanced paramedic practice, senior paramedics are required to support their own teams’ continuous professional development and training needs, whether that is through higher education institutions, in the workplace, or through e-learning.
Clinical excellence
NWAS aspires to develop a workforce of reflective practitioners who work with patients to make informed treatment and transport decisions, ensuring the right care, at the right time, and in the right place. Attaining a BSc is essential criteria for the senior paramedic.
Summary
NWAS’s clinical leadership model and supervisory structure sets out clear career development pathways for ambulance clinicians. It ensures the workforce is well educated, fully engaged and highly committed.
Conclusion
The clinical leadership structure supports the organisation’s objectives and future direction. Clinicians have a clear career pathway. The needs of the public are recognised and can be addressed in the most appropriate way; this can only mean continuous improvements for patients and staff alike.