Is there a future for independent prescribing by advanced paramedics?

Definition of advanced practiceThe CHM feel that the definition of advanced practice is not sufficiently robust, and that the perceived scope of practice is too wide for advanced paramedics to safely prescribe. The College of Paramedics describes advanced practice, and this definition was included in the submission to the CHM, but there is no standard and consistent definition of advanced practice across different healthcare professions. As paramedics, we have a further challenge in the wide range of roles and role titles that exist in different practice settings. While professional nomenclature may appear a minor issue for some, the basis for consistency in practice level can only be achieved if the role titles are simplified and used appropriately—allowing absolute clarity of what advanced practice is. Paramedics who progress through the career framework continue to be paramedics, and the diverse range of job titles that have proliferated have, in some examples, appeared to make generic the different professions that are engaged in a multi-professional healthcare model. We should be proud to be paramedics, regardless of where we are working, and I feel that it is not an understatement to say that this lack of consistency and resistance to consensus has been a contributor to our inability to demonstrate a definition of advanced practice sufficient to reassure the CHM.The original case for need that was produced by NHS England in collaboration with the College of Paramedics refers to independent prescribing by advanced paramedics as a way to reduce the impact that the limitations of the current mechanisms have on patient care. Across the differing levels of practice, exemptions are fit for purpose in emergency and critical care, and the use of patient group directions (PGD) have a utility for patients with urgent care needs, but are limited in the very patients for whom changes to healthcare delivery is aimed at for the future.Patients living independently or in supported living in the community, with one or more long-term health conditions, within an increasingly ageing population, are at the heart of the new models of care. It is increasingly apparent that paramedics provide care for these patients at times of crisis—either as 999 calls to ambulance services, attendance by out-of-hours providers, or in community- or acute-based urgent care settings. The usefulness of PGDs decreases as the patient becomes older and more co-morbid, and the basis for independent prescribing addresses these issues through proposing improved decision making and care planning options available to prescribers. The proposal for independent prescribing is limited to paramedics practising at advanced level—hence the need for increased clarity in role titles.

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