On the 4th July 1996 I joined Royal Berkshire Ambulance Service (RBAS) as a direct entry technician, or trainee assistant paramedic as we were called by RBAS. Six weeks of ambulance training, three weeks of driving, a week of local training and I was out on the road responding to 999 calls. My first shift was at Henley on Thames and the only job we went on that night was a murder . . . . I’d never even seen a dead body before, let alone someone who had been killed!
In my first (trainee) year I was asked at least three times by my mentor if I was sure if this was the right job for me. I was hopeless at talking to patients (well almost anyone) and the old boys (and girls) frequently commented that this was because I hadn’t served my time in PTS before becoming part of the 999 team. They were, however, very supportive, and helped me to survive the first few difficult years in such a challenging job.
A year later I started my 12-week paramedic course and qualified as an IHCD paramedic around 18 months after that first fateful shift. At that time a training officer turned up on the last Friday of your a & e placement, shook your hand and handed you a set of paramedic epaulettes for you to wear on your next shift! I think I was just about safe, clinically, but it was about 5 years into the job before I felt remotely comfortable talking to patients.
In those days, the only career pathway for a paramedic was within the ambulance service who also didn’t accept any non-ambulance qualification as any indicator of clinical or other competence. A career for life, or at least until your back gave out…
In the following 17 years I have completed a MSc in Advanced Healthcare Practice, spent 5 years in clinical management before returning to operational ambulance duties and was a clinical representative on the College of Paramedics Post Graduate Curriculum Guidance Group. I have three jobs: Specialist Paramedic (Urgent & Emergency Care) for South Western Ambulance Service NHS Trust, an Advanced Paramedic for Devon Doctors Ltd (our local OOH primary care provider) and I’m also joining the RAF reserves as a paramedic. And I think I’ve learnt how to talk to patients too.
There has been a lot of discussion, particularly on social media, about the HCPC’s announcement that they are soon only going to register new paramedics who have a degree, and is this a good thing for the profession? Surely, it’s people skills that are more important? So let’s discuss this, and I’d like to state that these are my opinions, not my employers’ or those of the College.
The paramedic profession is only about 30 years old in any form that we’d recognise today and ‘paramedic’ has only been a protected title since 2001. We are still a new profession, particularly when compared to modern nursing, which can be traced at least back to 1860 with the establishment of the nursing school at St Thomas’s in London by Florence Nightingale.
We used to be regarded, and by ourselves too, as the emergency part of the NHS. Unique, out on a limb, not particularly well integrated. This has changed massively in the last 20 years: now we’re a young, small profession (Figure 1) in the wider AHP community.
Even as a ‘frontline’ NHS paramedic, my role has changed massively in the last 20 years. Then it seemed to be about carrying people in and out of the ambulance as much as it was about clinical skills. Resuscitations often involved squirting large volumes of drugs down an ET tube while waiting for about 5 minutes for the defib to warm up. Everyone who was involved in an RTC was boarded, rapid takedown of patients who had managed to get out of their cars before we arrived were routine...Lidocaine for pulsed VT...IV tramadol for analgesia as we couldn’t give morphine.
How things have changed. I think I’m now expected to know almost everything about almost any condition (Google is my friend!). The demographics of my ‘ambulance’ patients appears to have changed. Increasingly I see complex patients with exacerbations of chronic conditions and those that would have previously accessed the NHS via other services such as primary care or would have just looked after themselves. On the flip side, we now use increasingly technical and complex equipment and a wider range of medicines. Resuscitations now potentially involve chest compression devices, biphasic defibrillation, drugs administered IO and significant emphasis on post ROSC care. On top of my paramedic exemption drugs (as defined by the Medicines Act), I’m now expected to use a combination of 54 medicine protocols and PGDs. The traditional NHS paramedic role is significantly more technical and academic than it used to be and I believe that the transition to a degree requirement for new registrants appropriately reflects these changes and developments, and not just in my Specialist role.
NHS England and the devolved nation equivalents are quite rightly trying to standardise aspects of AHP roles within the NHS, including titles, initial training and education. This has been facilitated by professional bodies along with other stakeholders such as HEIs and employers, and this is gradually coming to fruition. This will give colleagues, the public and aspirant AHPs an improved understanding of NHS roles and how they relate to each other, while, hopefully, enhancing patient care and safety. These include:
New entry to the relevant professional register requires a degree level qualification;
Progression to a ‘Specialist’ role requires a post graduate diploma and the relevant skills, knowledge and experience;
Progression to an ‘Advanced’ role requires a Masters degree and the relevant skills knowledge and experience;
Aspirant AHP independent prescribers should be working at ‘Advanced’ level, they must have the support from their employer, a doctor as a mentor, a role where prescribing is relevant and complete an approved course of study.
I know that not all Allied Health Professionals (AHPs) have achieved all of these aspects yet, and, please note, I am not talking just about paramedics, but AHPs in general.
Therefore, if you meet a specialist nurse, you will have an understanding of their competency and skill level, while they will also, hopefully, understand your ‘Advanced paramedic’ role.
For us, the College of Paramedics has been representing our profession in these developments and one of the first aspects to be published was the Paramedic Post Registration Career Framework (now in its 3rd edition). The Framework Diagram is below:
This has been enhanced by the Paramedic Post Graduate Curriculum Guidance document [insert link], published in 2017, and the Paramedic Digital Career Framework which is jointly published by NHS England and the College of Paramedics. Please take the time to have a look at these documents, they affect you, your colleagues and your profession.
The public, our professional colleagues and members of our own profession sometimes think of a ‘paramedic’ as someone who works on an NHS ambulance responding to 999 calls. These days, I think that’s a very blinkered and ill-informed view, even though that’s where most of us started out in our careers. A search of NHS Jobs for ‘paramedic’ yielded the following results:
• Health Visiting
• Ambulance Service
• Primary Care
• General Practice
• Emergency Services
• Community Health Services
• Forensic Services
• Adult Mental Health Services
• Senior Lecturer
• Health and Safety
• Prison Service
• 111 Clinician
• Immigration Services
The number and diversity of these paramedic roles continues to increase as new employers recognise our individual and collective skills, knowledge and experience. For everyone’s benefit we need to ensure that paramedics as a profession and as individuals are highly regarded and valued. The HCPCs requirement for new paramedics to have a degree is part of this. Rather than kicking against this change we should be celebrating the increasing inclusion of paramedics within the wider AHP community and the consequential recognition of the paramedic profession within the NHS and beyond.
As far as the original question of ‘do you need a degree to be a paramedic, surely people skills are more important’? No, you don’t need a degree. There are plenty of non-degree paramedics working in many roles. But I have four riders for this:
1. No paramedic course has consistently produced staff with good people skills. Mine didn’t, and that’s something that I think some of us can only develop over time. Having a degree or not isn’t linked to people skills. A new geeky paramedic who’s hopeless with patients may develop into someone who progresses far in their career. I did!
2. There are a number of paramedic roles which have little or no patient contact, but are quite academic. Please don’t be blinkered.
3. While you might not need a degree to do your job at the moment, your profession needs to progress with common AHP standards, including education, for the benefit of future paramedics, patients and UK healthcare.
4. The paramedic profession is increasingly complex, technical and requires an increasing level of academic as well as experiential knowledge. The changes in the last 20 years are incredible. The next 20 years are only likely to increase the complexity of our work and we need to demonstrate that we are individually up to the task ahead. Academic achievement will only be one aspect of this.
If you’re still unsure about this progressive change for our profession, then please talk to your degree qualified colleagues and perhaps consider a top up of your existing qualifications.
And no, personally I don’t think current degree courses reflect the needs of the profession moving forward. I’d like to see a greater congruence between the patients that we’re seeing, and are likely to see in our careers, and the content of undergraduate courses. I’d love to see consultation skills taught as compulsory modules in year one and two of all paramedic degree courses. That would potentially benefit every patient contact in our careers...and may address some of the ongoing concerns with interpersonal skills at the same time? And how about a module on ethics & risk management? Rant over, but HEI’s please note!
Remember, we’ve achieved in just over 30 years what it’s taken nursing about 160 years . . .
https://www.collegeofparamedics.co.uk/publications/post-reg-career-framework [insert link]
https://www.collegeofparamedics.co.uk/publications/post-graduate-curriculum-guidance [insert link]
Richard Taffler MSc BSc(Hons) BEng FASI MCPara