The HCPC and Paramedic Self Referral

Learning From the Past for a Better Future


The year is 2002 and paramedics have not long been registered with the HCPC. Having not been qualified long yourself there are certain colleagues you look up to, paramedics that you want to be like one day. One particular paramedic is Chris. Chris is tall, striking looking and an exceptional paramedic. Chris always seems to be able to deal with any situation the two of you had been in, whether that was cannulating a shutdown trauma patient trapped upside down in their car in the rain, or compassion for an elderly lonely patient, or even looking after you and your patient in the middle of a pub brawl. Always with a calmness and confidence that you and many others aspired towards.  

Like anyone who works in an Ambulance Service, you know all too well the regular patients that you encounter time and time again. In 2002 there is one particularly longstanding, regular caller, a man called Brian. Brian is in his 40s and calls 999 at best, daily, and at worst a lot more often. Brian lives alone in a state of chaos and neglect, he is alcohol dependant and does not work. He can often be verbally aggressive and sometimes inappropriate, particularly towards women. In fact, there is a flag on his property that double female crews should not attend. Brian always calls 999 complaining of chest pain but will very rarely travel to hospital, usually refusing to go anywhere. Brian has Angina and a GTN spray as he has had previous MIs. Colleagues never want to go to Brian as he is challenging to know what to do with and you know that at some point he will die and one of you will be the last person to see him alive. 

One day, it is Chris that gets the call to respond to Brian’s address. Brian is particularly aggressive, shouting and threatening violence, the police have already been called by a worried dispatcher due to his demeanour over the phone. Chris and the police try for some time to calm Brian down and understand why he had called 999, but eventually gave up as he wouldn’t let them anywhere near him, and was telling them in no uncertain terms, to leave his property. So, Chris, crew mate and police leave Brian’s house.   

Brian is found dead by a neighbour the next day. 

The Ambulance Service does not investigate but refers Chris straight to the HCPC. Chris is kept busy gathering evidence to show just how often Brian called 999, how he always rang with chest pain and how often he was abusive towards ambulance colleagues. Chris collects evidence and testimonies to demonstrate outstanding clinical expertise and excellent character. Chris has a huge blue folder with all the comprehensive statements and official documents ordered perfectly for ease of reference. Little did you know at the time that this was not at all what the HCPC wanted. But you knew no better. Management knew no better. Nobody around Chris knew any better.  

Several months went by, the hearing came. Chris got struck off the register.               

How could this happen to someone like Chris? A solid paramedic that anyone would want at their side at a bad job, and someone you would want to turn up if your family was in need. You just can’t understand it. Everyone is shocked. The news spreads at a speed usually reserved only for the juiciest of gossip! And so does the fear, the fear that this could happen to any of you, at any moment. 

The fear had consequences. After a while nobody knew what was fact and what was fiction in Chris’s story. Stories were told constantly, and myths were created surrounding the HCPC - the HCPC is punitive, they’re out to get you. It is better to self-refer, because it will look better on you rather than coming from the Ambulance Service. These stories becoming ingrained in ambulance and paramedic culture. The Ambulance Services increasingly used the HCPC instead of their own investigative process. They would wait to see what the HCPC said before they decided what to do. There is no doubt that this happened across many of the Ambulance Services at the time, there were more than 30 back then.  And so, the scene was set for the following years… 

The aim of this piece is to raise awareness and understanding about a hugely unnecessary self-referral rate, how that came to be and how we can reduce it by thinking and behaving differently. The College of Paramedics is working with the Association of Ambulance Chief Executives, the national Directors of HR and Trades Union organisations to ensure a full awareness of the current situation regarding paramedic self-referral rates and to drive changes that will support and benefit individuals and the paramedic profession in the future. 
For more information on Fitness to Practice self-referral and legal representation click here  

Liz Harris FCPara
Head of Professional Standards, College of Paramedics