The Paramedic Practitioner Programme

1. The Paramedic Practitioner Programme NHS Health Education Kent Surrey & Sussex South East Coast Ambulance Service NHS Foundation Trust (SECAmbNHSFT)

2. The Paramedic Practitioner Programme 1 • Innovative Scheme • Degree course • Paramedics who are recruited who have 5yrs+ in the ambulance service • Aim to share with Paramedics the skills of Primary Care • Prevent unnecessary admissions • Provide an integrated service which can be taken to patients in their home

3. The Paramedic Practitioner Programme 2 • Working towards co-ordinated care with community services • Competency based Curriculum • Based on clinical knowledge and skills development • For selected Paramedics- a 14 month pathway • Devised by SECAmb following review of ECP (Emergency Care Practitioner) programme, currently taught at St George’s • Congruence with DoH NHS strategy

4. The Paramedic Practitioner Programme3 • Programme development: • 2 year workplace based programme pilot • Roll out in KSS GP Training Practices • Evaluation • Collaborative development of Curriculum document • Recruitment and implementation • Current ‘experienced’ Paramedics • Future career pathway for graduate Paramedics

5. The GP Placement Content1 • Acute presentations in GP in Primary Care: • working in different environments • clinical assessment, management, • communication, continuity of care • wide spectrum of presentations • Consulting skills: • GP models vs traditional medical model • Clinical examination skills: • beyond traditional paramedic training

6. The GP Placement Content2 • Treatment skills: • suturing, minor abscess drainage, • appropriate medicine management using Clinical Management Plans (CMP)s & Patient GroupDirectives (PGD)s, • ‘The paramedic as the drug’ (after Balint) • Team-working in primary care teams • Familiarisation with GP IT systems • Introduction of the Generalist Role

7. Teaching and learning • Time table for 2 months • 37.5 hr week (vaiable) • Induction to whole team, building relationships, understanding roles. • Tutorial weekly (link with case based discussions), time for assessments • Needs assessment • Staged progression as with GP STs, initial observation/joint/independent practice

8. Evidence based Clinical Management Plans PatientGroupDirections for any treatments in these plans

9. Clinical Management Plan for Gastroenteritis CMPs are developed by Paramedics + GPs. Approved through SECAmb NHSFT governance processes

10. Inter-professional model of Learning and Teaching

11. Assessment of the PP in GPCollecting the evidence Using the tools of the Workplace Based Assessments: Case-based Discussion Consultation Observation Tool Multi-Source Feedback Patient Satisfaction Questionnaire Clinical Evaluation Exercise (Mini-CEX) Clinical Supervisors Report

12. The Paramedic Practitioner Curriculum Framework, Rationale and Competences Document South East Coast Ambulance Service NHS Foundation Trust. (SECAmbNHSFT) St Georges University of London and Kingston University South East Coast NHS Strategic Health Authority Health Education Kent Surrey and Sussex PCTs Surrey, Sussex and Kent, Royal College of General Practitioners Patient Representation Curriculum Development

13. PARAMEDIC PRACTITONER PROGRAMME

14. HEKSS pilot PP placement programme Evaluation Report Prof Annemarie Rushton

15. Key findings of first placements - general • Highly successful and valued programme • Wide spectrum of patients and conditions • Competencies developed: • Communication & consultation • Data gathering • Making differential diagnosis • Clinical management

16. Key findings of the first placements– PP perspective • The style of teaching and supervision • Sound work based, experiential environment • Supervision by trained educators • Based on assessed needs and learning styles • Cemented theoretical learning > practice • Process problems with assessment • Format • Volume • Time and inconvenience to all

17. Key findings of first placements – GP perspective PP students • Motivated and self-directed • Improved on all competence areas • Are or will be autonomous practitioners Business issues • ‘Frontloaded’ – clinical time lost at beginning • Needed to understand before exposing ST3 Happy to take further PPs

18. Evaluation Recommendations • Streamlining workplace based assessments • Calibration for supervisors [ST3 & other GPs] • Clearer introduction / induction guidance • Potential benefits for hosting PP students • Business case to training practices • Selection / screening less appropriate PPs • Poor team-working, poor assessment skills

19. Where to from here? • Roll out the SECAmb NHSFT / HEKSS PP programme • Consolidate existing GP training practice placements • Introduce new GP training practices • Continue the developmental dialogue • Involve the ST3s and other GPs • Further the interaction / relationship between GP and PP educators • Integrate PPs in local primary healthcare community • Nationally, open up the PP examination to other Ambulance Trusts • Apply to join RCGP Foundation for CPD support.

20. PP Exam Development

21. PP Exam – RCGP accredited

22. OSCE exam [and resit] 2011MRCGP CSA centre, Croydon

23. Summary 1 Good example of integrated care. Excellent opportunity for ST3 trainees to become involved in teaching and assessing. Excellent opportunity for Paramedic Practitioners to learn about Primary care.

24. Summary 2 A good opportunity to help our patients by giving them appropriate continuity of care in the community. Decrease admissions, save money for PBC groups. Good for the practice team to form links with Paramedics.