The paramedic profession was officially 10 years old in November—or to be more precise, we have completed our first decade as registered health professionals, which is certainly worth celebrating. It is also an opportune moment to both reflect on what has been achieved and to look forward at what opportunities lay ahead.
Progress
Perhaps the biggest single prize that we still need to seize is unlocking the full potential of our profession and this means making paramedics ever more relevant and effective in meeting emerging patient need through the development of scope of practice.
There has been limited and rather fumbling progress here—both in terms of the move from training to education and particularly in respect of the post-registration training where paramedics are providing care to the ever-increasing number of patients with less critical undifferentiated urgent care needs. Nevertheless, much remains to be accomplished and there are both challenges and promising developments in equal measure.
Challenges
Disappointingly, the NHS staff census (NHS, 2009) reported only 720 paramedics as working at ‘practitioner,’ i.e. ‘specialist practice’ level in the ambulance service and the numbers being trained have certainly reduced recently, with some commentators suggesting that overall numbers are falling. The variation among schemes and training approaches has not helped either and there is even widespread and entirely avoidable confusion in some quarters over simple issues such as what to call paramedics who have undergone such training and education.
This last point is easy to resolve given that the Health Professions Council (HPC) regulates the protected title ‘paramedic.’ As a consequence, it is expected paramedics with an extended scope of practice continue to use the designation that contains the professional title that is protected by law, for example ‘specialist paramedic.’
The College of Paramedics have produced a helpful Position Statement on the subject, which is published on the next page. Hopefully, confusing and less appropriate titles such as the rather unhelpful so-called ‘emergency care practitioner’ (ECP)’ terminology, a product of the long defunct Modernisation Agency, can be retired to give way to more accurate terminology.
Standards
Help is also on hand to address the matter of accredited standards for extended practice. Recent work by the Royal College of General Practitioners, (RCGP), the College of Paramedics and St George’s hospital have resulted in the development of a new examination, piloted last year, but which will be more widely available from 2011.
This examination, which includes both written and practical assessments, will enable those working at specialist paramedic level, with primary care skills, to be able to attain recognition of their expertise through the successful completion of this examination.
For the first time, there will be a national standard and one that comes with a first rate and independent pedigree, with endorsement from the RCGP and the College of Paramedics. Look out for more information on this in forthcoming issues of JPP.
Managing patients with undifferentiated urgent care presentations has been the main focus of specialist practice, but it is unlikely to remain the only area, although arguably the most important, and some of these skills may be reverse engineered into the pre-registration preparation of paramedics.
Opportunities
Opportunities will increase, as with medicine, nursing and our other AHP colleagues, which provide a wide range of post-registration career specializations for their graduates. In addition to specialist paramedics working in primary care, the more recent development of critical care paramedics (CCP’s) is likely to increase and there are already two universities offering programmes, generated from an NHS curriculum development grant. We can expect these paramedics to play a major role in the recently proposed ‘enhanced care and medical emergency incident response team (MEIRT)’ initiatives.
Conclusion
The future is therefore bright, with ever more capable paramedics seeking post-registration development opportunities and delivering more care that meets the ever changing needs of patients in an increasingly clinically and cost effective way. With luck, we may also clear up title confusion and actually call them ‘specialist paramedics’.