Advancing practice through the lens of patient care

Just over a decade ago, when I first registered with the Health and Care Professions Council (HCPC) (then the Health Professions Council), I did not picture a career outside of the back of an ambulance—unless I ceased to be a paramedic entirely. Yet, over the last 10 years, one of the main components that has catalysed the development of the profession is the idea that paramedics could capitalise their generalist unique selling point (USP) to work to an enhanced clinical level. The development of the paramedic profession itself is not new—we have continuously developed since our inception from working clinically within the constraints of providing life support under the supervision of cardiologists, to being autonomous clinicians in our own right. However, the progression to working within advanced practice has been something new—and I think we have the changing model of care delivery within the ambulance service to thank for this. Ambulance services were historically based on a retrieval model of care, where ambulances are dispatched to patients and convey them to further care, perhaps with some emergency treatment en route. However, based on changing healthcare demands and the oft-touted 5% of 999 calls constituting an emergency (NHS England, 2014), UK ambulance services have had to adapt their model to focus on delivering care to a more urgent, less emergent, group of patients. One way to help meet rising service demand is by developing a workforce that can adapt and respond, maximising existing roles and expanding clinical practice. I think that it was through the various schemes developed to respond to this ‘new’ group of patients in the ambulance service, in which the clinical skills and capabilities of the paramedic were enhanced beyond what was considered traditional paramedic practice, that paramedics proved their worth in being able to operate at an advanced level of clinical practice— and, more latterly, within different clinical settings entirely.