The role of the paramedic and paramedic practice continues and will continue to progress. Challenges in the delivery of health care have prompted governments and the profession to give serious consideration to expanding the role that the paramedic plays in healthcare systems. However, the advanced role and the developing scope of practice, safety and efficacy are currently poorly understood. Further research is needed in order to fully appreciate how the scope of practice as well as expanding the paramedic's role impacts on patients, communities, the profession and health and care systems (Bigham et al, 2013).
The Health and Care Professions Council
The Health and Care Professions Council (HCPC) is a regulatory body set up with the key aim of protecting the public. In order for them to do this they maintain a register of health and care professionals who are able to demonstrate that they have met the HCPC standards for training, professional skills, behaviour and health.
Professional and legal frameworks largely govern the work of the paramedic at the point of registration. The HCPC (2014)Standards of Proficiency—Paramedics sets out the standards of proficiency expected of the paramedic to perform safely and to deliver effective care. The standards are threshold standards considered by the HCPC that are required to protect the public. In these standards the HCPC set out what it is a student is required to know, understand and be able to perform when they reach the point of registration, enabling them to make an application to the HCPC to register. When registered the paramedic has to continue to meet those standards of proficiency relating to the areas in which they work.
Along with the Standards of proficiency, the HCPC also expects that the paramedic will adhere to the requirements stipulated in the Standards of conduct, performance and ethics (HCPC, 2008), as well as the Standards for continuing professional development (HCPC, 2012).
Scope of practice
Scope of practice is a term that is used for the area of someone's profession in which they have the knowledge, skills and experience to practice safely and effectively, according to the standards prescribed by a profession or a regulatory body.
Upon registration with the HCPC, the paramedic practises as an accountable, autonomous first contact practitioner. The paramedic is required to undertake a range of diagnostic and treatment activities as well as directing and signposting care appropriately; they treat those who experience health problems due to injury, illness, or an exacerbation of a chronic illness.
Paramedics practice in various environments and settings which can include public, private and military sectors, offering care to an individual or providing care to a number of people involved in major incident situations. Paramedics also take on roles and responsibilities in health promotion and admission avoidance, these reflect the context of care as being a ‘health’ and ‘illness’ service.
The paramedic's scope of practice is the area or areas of practice in which they have the knowledge, skills and experience to practise lawfully, safely and effectively in such a way that this aligns with the HCPC's standards and will not present any harm to the public or to the paramedic. It is impossible to detail the scope of practice the paramedic undertakes or will undertake as this will change over time, although attempts to do this have occurred (College of Paramedics, 2015a). The practice of the experienced paramedic often becomes more focused and specialised than that of newly registered paramedics. Regardless of this the paramedic must declare (every time registration is renewed) that they continue to meet the standards of proficiency that apply to the paramedic scope of practice (HCPC, 2012; 2014).
The College of Paramedics (2015a) has produced a Paramedic—Scope of Practice Policy document that aims to provide clear and definitive information regarding paramedic scope of practice at the point of registration. The College of Paramedics (2015a) remind paramedics that they are autonomous practitioners who have the knowledge, skills and clinical expertise to assess, treat, diagnose, supply and administer medicines, manage, discharge and refer patients in a range of urgent, emergency, critical or out-of-hospital settings. Their publication appears during a period of austerity, economic restrain and investment and staff shortage.
The HCPC (2014) defines a registrant's scope of practice as:
‘The area or areas of your profession in which you have the knowledge, skills and experience to practise lawfully, safely and effectively, in a way that meets our standards and does not pose any danger to the public or yourself. We recognise that a registrant's scope of practice will change over time and that the practice of experienced registrants often becomes more focused and specialised than that of newly registered colleagues. This might be because of specialisation in a certain area or with a particular client group, or a movement into roles in management, education or research.’
During these difficult economic times policymakers are faced with many challenges, not least of which are legal, and regulatory debates that often focus on how to maximise the use of all healthcare practitioners along with the debate among healthcare practitioners, regarding the continuous growth of scopes of practice. Scope of practice is defined by the ‘who’, ‘what’, ‘where’, ‘when’, ‘why’, and ‘how’ of paramedic practice. However, the HCPC's (2014) definition fails to address advanced paramedic practice. The reason for this may be that there is no generally agreed consensus on what advanced practice is within the paramedic profession and within other professional groups.
‘Scope of practice is a term that is used for the area of someone's profession in which they have the knowledge, skills and experience to practice safely and effectively’
Proposed changes to a healthcare profession's scope of practice often brings with it strongly worded comments from many corners, including professional interest groups. Often these debates are seen as turf wars between two or more professions with the usual retort: ‘This is part of our practice so it can't be part of yours.’ Regularly what gets lost among these opposing arguments and claims are the most important issues of whether the proposed changes are able to better protect the public and improve patient access to competent healthcare services.
The College of Paramedics' (2015b) curriculum guidance has been developed and significantly revised in such a way that they acknowledge that most professions today share some skills or procedures with other professions. In contemporary practice it is no longer reasonable to expect that each profession will have a completely unique scope of practice that excludes all others. Any scope of practice changes should reflect the development of the abilities of each healthcare discipline; silo working would be detrimental to enhancing patient outcomes.
Any consideration of scope of practice has to be focused on patient safety. Those involved in paramedic practice from grass roots level to senior executive level, including service users, must be a party to any scope of practice developments and discussions that are being considered. If these issues are not given serious consideration, then there is no point in developing or proceeding with any scope of practice service developments. It would be naïve to suggest that the introduction of an advanced scope of practice would not benefit current economic difficulties faced by many ambulance Trusts. That said, the fiscal benefits that will arise out of any scope of practice initiative should be shared in an up front and transparent manner.
Paramedics are able to practise safely with an expanded scope and improved system performance and patient outcomes. They must, however, be provided with the tools to excel to demonstrate competence and confidence, and the provision of continuing education opportunities in order to inform practice. This is in addition to appropriate remuneration and recognition for the additional higher level work and the critical decisions that they are expected to make as a result of expanding, advancing or modifying the scope of practice.