College of Paramedics’ Position Statement on the designation of paramedics: Undertaking Extended Scope of Practice

HistoryA number of developments have occurred to address the professional needs of paramedics to have a scope of practice that matches the changing demand from both patients and the NHS requirements.Practitioners in emergency care (PEC)In 2000, the Joint Royal Colleges Ambulance Liaison Committee (JRCALC), in partnership with the Ambulance Service Association (ASA), proposed the development of practitioners in emergency care (PEC) to broaden the skills and knowledge of paramedics in order that they could meet the diverse requirements of patients, particularly those with undifferentiated but not life-threatening health care requirements.The role of the PEC was designed to ‘up-skill’ the workforce and support modernization efforts. Many ambulance professionals were keen to expand their roles and such advancement had wide support from the trade unions.Quality Assurance Agency (QAA) Benchmark StatementThe Benchmark Statement produced by the QAA at the request of the DH and with the involvement of the Health Professions Council (HPC), clearly identified that paramedics should have the competency set to meet patient demand, and specifically enhanced patient assessment and clinical decision–making. The document also embraced the EU system directives relevant to paramedics (QAA, 2004).The British Paramedic Association (BPA) Curriculum GuidanceThe BPA produced the first Curriculum Guidance for the profession in February 2006 (BPA, 2006). This document included a career framework for paramedics with the level of ‘paramedic practitioner’ reflecting an increased primary care role for paramedics, embracing the concept laid down in the QAA statement.Allied health professions with a special interestThe DH acknowledged the value of paramedics with an extended scope of practice in the form of community paramedics in the document, Implementing a scheme for allied health professionals with special interests (DH, 2007).Ten Key Roles for Allied Health Professionals (DH)In August 2003, the DH published the ten key roles of AHPs to clarify the role and what they should aim towards. It indicated that all AHPs (including paramedics) should be able to act as the first point of contact for patient care having the skills of diagnosis, ordering diagnostic tests, prescribing, discharge, referral, teaching and health promotion. (DH, 2003).Standards of Proficiency (HPC)The current Standards of Proficiency (HPC, 2007) for paramedics reflect that all paramedics should be able to undertake full patient assessment, have clinical reasoning skills and refer patients appropriately.Taking Health Care to the PatientThe DH report, Taking Healthcare to the Patient (2005), outlined the need to develop a paramedic career framework in line with the changing workload demand.The Allied Health Professional Career FrameworkThere are 15 groups of allied health professionals, with paramedics joining the ranks of AHPs in November 2000 as the twelfth professional group to be admitted to the register. The NHS AHP Career Framework applies to all AHPs and provides an opportunity to build a clinical career path within each professional group.Emergency care practitioner (ECP) developmentAlongside paramedics developing within the higher education setting as first contact practitioners (following QAA, HPC and BPA standards), the NHS Modernisation Agency adopted the PEC concept and called this an ‘emergency care practitioner’ (ECP).The British Paramedic Association (BPA) Curriculum Guidance (Second Edition)The College of Paramedics; (BPA) issued the second edition of the Curriculum Guidance in January 2008. This document, which was revised following wide stakeholder input, clearly identifies the role of the paramedic and associated competency set. It also outlines a scope of practice and a career framework for specialist, advanced and consultant paramedics.Critical care paramedicsMany of the approximately 750 paramedics who have undergone clinical development in the specialist paramedic role undertake responsibilities in the area of managing patients with undifferentiated primary health care needs.More recently, roles to support improvements to services for patients with serious injury and illness have been developed. The NHS has funded a curriculum for this role and two universities offer programmes designed to produce critical care paramedics.These staff are trained to plan a role in the delivery of trauma and resuscitation care and have a developing scope of practice geared to these needs, potentially fulfilling elements with ‘enhanced care team,’ or similar initiatives.

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