HEE Announce New Road Map to Advanced Practice in Primary Care

21/01/2021

 


Paramedics have, for many years now, been choosing primary care as the pathway for their professional development. This new initiative from Health Education England (HEE) will build on the strong foundations created by those paramedics who already work in a variety of roles across primary care.

The educational training pathway to Advanced Paramedic Practice in primary care will first see clinicians develop the clinical pillar of advanced practice, either by a portfolio route (for those with existing competency and education) or by a taught route in partnership with Higher Education Institutions.

Following completion of initial paramedic education and a period of consolidation in professional practice, the paramedic aspiring to work at advanced practice level in primary care will first work towards becoming credentialled as a First Contact Paramedic (FCP). Credentialling as an FCP will use a portfolio or taught route to evidence achievement of clinical competency in two stages, as outlined in the First Contact Practitioners and Advanced Practitioners in Primary Care: A Roadmap to Practice (Paramedics). Credentialling and a register of clinicians who achieve each level will be overseen by the HEE Centre for Advancing Practice.

First Contact Paramedics will work in a diagnostic role, seeing a broad range of undifferentiated and undiagnosed conditions as the first point of contact. Clinical knowledge will be developed at academic Level 7 (Stage 1), and clinical expertise will be evidenced by Workplace Based Assessment (WBA) undertaken with clinical supervisors in primary care (Stage 2).

The table below provides information as to the differentiation between First Contact and Advanced Practice for paramedics working in primary care:



Progression to Advanced Practice in primary care will, for most, follow a taught route via a Higher Education Institution, achieving an MSc in Advanced Practice (or equivalent). Alongside continuing to develop as a clinician, with supervision and ongoing development – credentialing as an Advanced Practitioner requires the individual to demonstrate competency and capability in education, leadership and research (Four Pillars of Advanced Practice).

The College is supportive of this framework, which provides paramedics with a clear pathway to achieve their aim of working in primary care. The framework also offers those currently working in primary care with guidance and clarity for clinical supervision and opportunity to evidence their education, training and core competencies in order to credential via the portfolio route.

The College of Paramedics is actively working with HEE and the Centre for Advancing Practice to determine the role of professional examinations, such as the Diploma in Primary and Urgent Care offered by the College, to support paramedics to credential as Advanced Practitioners in primary care.
 
Click here to read the New Road Map to Advanced Practice in Primary Care.

Enquiries should be sent to primarycare@collegeofparamedics.co.uk and a member of the team will be in touch.

    


Perform or Panic? Challenge or Threat?

By Joanna Train

04/01/2021

Picture: Roger Brown 


Reappraisal strategies for improving performance in a stressful situation.
Joanna Train is currently an MSc Sports Psychology student with an interest in applying sports psychology performance strategies to supporting emergency responders deal with high pressure situations. Click here to read Joanna’s piece.

The Paramedic Case for Safer Streets

By Jules Mattsson, Student Paramedic and committee member of the London Cycling Campaign in Hackney

27/11/2020

 

An ambulance response car uses a protected cycle lane to bypass general traffic. Picture: Cyclingmikey

As the Covid-19 pandemic continues, one big change for residents of towns and cities has been how we get around. With public transport capacity reduced, many took to private cars to avoid the guy wearing a mask under his chin while sitting opposite you on the train. Unfortunately, if this trend had continued we were heading towards long-term gridlock - so urgent action was needed to enable alternatives like walking and cycling.

Fast forward a few months and we’ve seen Low Traffic Neighbourhoods (LTNs) and pop-up bike lanes appear across the country, following new government guidelines. LTNs use filters to calm residential streets - preserving vehicle access to all addresses but removing through routes (Living Streets, 2020) and improving space for social distancing - while protected lanes make cycling a safer (Lusk et al, 2011) and more attractive (Hull and O’Holleran, 2014) transport option. These trials started with public consultation running alongside rather than before them, unusually, and have not been without controversy.

A recent headline read “Top paramedic warns bike lanes are holding up ambulances in traffic jams” - with the newspaper describing them as “paralysing Britain” - while concerns over the emergency services are often cited by LTN opponents. I suspect many have horror stories of emergency responses being delayed by the sheer weight of traffic, dodgy parking, and questionable drivers - but these seem to be accepted as inevitable. Our field strives for evidence-based practice, so I’d like to examine the evidence for bold changes towards safer, healthier streets.

We know how time critical certain calls are, this is reflected in the College’s concern that LTNs and bike lanes could delay ambulances, but well-designed infrastructure can actually enable quicker response. In Walthamstow, London since a series of LTN-like schemes were installed in 2014 - Fire Brigade response times actually went down (LFB, 2020) while King’s College (2018) researchers found that life expectancy for local residents went up. Both of these changes are likely to be, simply, the result of fewer vehicles on the area’s roads.

With cycle lanes, as well as encouraging people out of cars and onto more space efficient bikes for shorter journeys, wide segregated lanes can be accessed by ambulance vehicles to bypass traffic. Narrower lanes that replace parked cars with bendy bollards, meanwhile, make it easier for drivers to pull aside and well-designed LTNs have seen emergency services able to fly through streets that previously suffered localised gridlock.


A London ambulance passes through an ANPR traffic filter. Picture: Oval LTN

It’s fair to say that recent changes have been of varying quality. Some LTNs use Automatic Number Plate Recognition (ANPR) filters to ensure rapid emergency access via any route, while others have cheaper unlockable bollards and specific unfiltered routes for emergency vehicles - which are sometimes defeated by outdated ambulance navigation systems.

The use of ‘hard’ point closures like bollards and planters often forms part of the design mix, but unlocking bollards if the standard entry/exit points are unsuitable takes time - so permeable ANPR filters at key access points would likely be preferable for response driving. Though there is a lack of published research on the interaction between emergency responders and LTNs, ambulance services are among the consulted bodies who must be involved in a scheme’s design. Many UK cities have historic LTNs (Laker, 2020), with no documented emergency access issues for these areas.

Since the advent of apps like Waze, traffic using minor residential streets has increased by around 20 billion vehicle miles in ten years (DfT, 2020a), with every mile driven on a minor urban road posing a greater risk of pedestrian injury than if it was on an A road (Aldred, 2019). Residential streets cannot safely cope with so many drivers following satnavs along any available shortcut, so LTNs reduce this overflow of the main road network.


A graph showing the increase in traffic on minor roads, from
https://roadtraffic.dft.gov.uk/summary

Main roads will often see some initial increase in vehicles as a result of LTNs, where volume traffic had previously been displaced onto unsuitable minor roads. As alternatives to driving are made easier and short car journeys made harder through infrastructure changes, residents tend to reduce their car use (Aldred, 2020). This paradoxical phenomenon of evaporating traffic (Cairns et al, 2002) has, in previous schemes, seen main road volumes level out or decrease over time - with a large overall reduction in traffic across an area (LCC, 2020). The resulting drop in traffic numbers frees up road space for those of us who need it.

In public health terms, air pollution has been called this country’s “largest environmental risk” to health, linked to tens of thousands of annual deaths (PHE, 2019). In London, for example, vehicles are the single biggest cause and our children lose around 10% of their lung capacity to pollution (TfL, no date). Considering the particulate emissions from tyres and brakes, a shift towards electric vehicles alone cannot negate this harm. LTNs reduce air pollution in residential areas by stopping ‘rat running’ and discouraging driving short distances - while infrastructure for alternatives to driving facilitates this broader ‘modal shift’ away from cars.

A lot of work goes into improving outcomes from trauma, the world’s leading cause of death and disability for under 40s (Krug et al, 2000), but we must also look at root causes. According to injury data, a third of major trauma in the UK is still caused by Road Traffic Collisions (Kehoe et al, 2015). In 2018/19, adult and child pedestrians and cyclists made up 37% of those killed and seriously injured in British collisions (DfT, 2019), showing the need for safer street design. This is reflected in the fact that all of London’s Major Trauma Centres have previously called for more protected bike lanes in the city (Kenyon, 2014).

We are also in an obesity and inactivity crisis, with physical inactivity behind one in six UK deaths, childhood obesity on the rise and our population’s movement levels declining over time (PHE, 2016). So-called ‘active travel’ is an important solution, incorporating exercise into daily life, and has been shown to significantly improve health (Celis-Morales et al, 2017). There’s an abundance of evidence (CeGB, 2020) suggesting the main barriers to active travel are safety perceptions. A recent government survey found 66% of English adults felt "it is too dangerous for me to cycle on the roads" (DfT, 2020b). Compare this to the Netherlands, where protests over children killed by cars were a catalyst for protected infrastructure - and cycling is now commonplace (van der Zee, 2015).

Such are the strengths of the health arguments in favour of street design interventions, many of which were also called for by NHS leaders to help their staff travel safely during the Covid pandemic (Kelly, 2020), that healthcare providers are now getting involved themselves in creating new schemes. There are three newly proposed LTNs in deprived parts of South London which are to be part-funded and studied by Guy's and St Thomas' NHS trust’s charity - to help tackle childhood obesity and air pollution around local schools (Salisbury, 2020).

New schemes need to be bold to be effective, and need time to work, but have already shown their worth. Paramedics see the harms of traumatic injury, preventable illness and congestion every day. We have an important voice in the future of our streets - which are now changing rapidly.

We must be part of the conversation, ensuring the needs of the emergency services are a key part of new designs, but the evidence suggests we should avoid joining the chorus of voices that stand against change altogether. The status quo isn’t working, so let’s stand up against preventable harm, and for better public health.

Author: Jules Mattsson, Student Paramedic and committee member of the London Cycling Campaign in Hackney. Twitter: @julesmattsson


Reference list:

Aldred, R. (2019) 'Motor traffic on urban minor and major roads: impacts on pedestrian and cyclist injuries', Proceedings of the Institution of Civil Engineers - Municipal Engineer, Volume 172 Issue 1, pp 3-9. Available at: https://www.icevirtuallibrary.com/doi/full/10.1680/jmuen.16.00068 (Accessed: 17 November 2020).

Aldred, R. (2020) 'Low Traffic Neighbourhoods: what is the evidence from the mini-Holland interventions?', Rachel Aldred, 1 September. Available at: http://rachelaldred.org/research/low-traffic-neighbourhoods-evidence/ (Accessed: 18 November 2020).

Cairns, S, et al. (2002) 'Disappearing traffic? The story so far', Proceedings of the Institution of Civil Engineers - Municipal Engineer, Volume 151, Issue 1, pp 13-22. Available at: https://nacto.org/wp-content/uploads/2015/04/disappearing_traffic_cairns.pdf (Accessed: 18 November 2020).

Celis-Morales, C, Lyall, D, et al. (2017) 'Association between active commuting and incident cardiovascular disease, cancer, and mortality: prospective cohort study', British Medical Journal, 357 (j1456). Available at: https://www.bmj.com/content/357/bmj.j1456 (Accessed: 17 November 2020).

'Barriers to cycling' (2020) Cycling Embassy of Great Britain Wiki. Available at: https://www.cycling-embassy.org.uk/wiki/barriers-cycling (Accessed: 17 November 2020).

Dajnak, D, Walton, H, et al. (2018) Air Quality: concentrations, exposure and attitudes in Waltham Forest. King’s College London. Available at: https://drive.google.com/file/d/1MGyThE5H9lgrzhCkjQlKKg7vhuW6pGMR/view (Accessed: 17 November 2020).

Department for Transport (2019) Reported road casualties in Great Britain: provisional estimates year ending June 2019. Statistical Release. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/848485/road-casualties-year-ending-june-2019.pdf (Accessed: 17 November 2020).

Department for Transport (2020a) Road traffic statistics. Available at: https://roadtraffic.dft.gov.uk/summary (Accessed: 17 November 2020).

Department for Transport (2020b) Walking and Cycling Statistics, England: 2019. National Travel Survey. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/906698/walking-and-cycling-statistics-england-2019.pdf (Accessed: 17 November 2020).

Hull, A and O’Holleran, C. (2011) 'Bicycle infrastructure: can good design encourage cycling?', Urban, Planning and Transport Research, 2(1), pp 369-406. Available at: https://www.tandfonline.com/doi/full/10.1080/21650020.2014.955210 (Accessed: 17 November 2020).

Kehoe, A, Smith, JE, et al. (2015) 'The changing face of major trauma in the UK', Emergency Medicine Journal, 32, pp 911-915. Available at: https://emj.bmj.com/content/32/12/911 (Accessed: 17 November 2020).

Kelly, J. (2020) We need StreetSpace. Available at: https://keyworkerspace.ghost.io/streetspace/ (Accessed: 18 November 2020).

Kenyon, J. (2014) 'London’s Major Trauma Centres: ‘Build protected cycle tracks across London’', CyclingWorks, 8 December. Available at: https://cyclingworks.wordpress.com/2014/12/08/nhs-trauma-centres/ (Accessed: 19 November 2020).

Krug, E, et al. (2000) 'The Global Burden of Injuries', American Journal of Public Health, 90 (4), pp 523-526. Available at: https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.90.4.523 (Accessed: 17 November 2020).

Laker, L. (2020) 'Smashing the tyranny of the status quo: 10 of Britain’s historic hidden-gem LTNs', Zag, 6 October. Available at: https://mindthezag.com/places/smashing-the-tyranny-of-the-status-quo-10-of-britains-historic-hidden-gem-ltns/ (Accessed: 20 November 2020).

Living Streets (2020) Low Traffic Neighbourhoods. Available at: https://londonlivingstreets.com/low-traffic-liveable-neighbourhoods/ (Accessed: 17 November 2020).

London Cycling Campaign (2020) Waltham Forest’s mini-Holland schemes, the evidence. Available at: https://www.lcc.org.uk/pages/number-wfminiholland-evidence (Accessed: 18 November 2020).

London Fire Brigade (2020) Fire Facts Incident response times 2019. Available at: https://data.london.gov.uk/dataset/incident-response-times-fire-facts (Accessed: 17 November 2020).

Lusk AC, et al. (2011) 'Risk of injury for bicycling on cycle tracks versus in the street', Injury Prevention, 17, pp 131-135. Available at: https://injuryprevention.bmj.com/content/17/2/131.info (Accessed: 17 November 2020).

Public Health England (2019) Review of interventions to improve outdoor air quality and public health. Available at: https://www.gov.uk/government/publications/improving-outdoor-air-quality-and-health-review-of-interventions (Accessed: 17 November 2020).

Public Health England (2016) Health matters: getting every adult active every day. Available at: https://www.gov.uk/government/publications/health-matters-getting-every-adult-active-every-day/health-matters-getting-every-adult-active-every-day (Accessed: 17 November 2020).

Salisbury, J. (2020) 'Guy’s And St Thomas’ Charity Will Fund New LTNs Over Health Benefits', Southwark News, 18 November. Available at: URL (Accessed: 18 November 2020).

Transport for London (no date) London's air quality - how bad is it?. Available at: https://tfl.gov.uk/corporate/about-tfl/air-quality (Accessed: 17 November 2020).

van der Zee, R. (2015) 'How Amsterdam became the bicycle capital of the world', The Guardian, 5 May. Available at: https://www.theguardian.com/cities/2015/may/05/amsterdam-bicycle-capital-world-transport-cycling-kindermoord (Accessed: 17 November 2020).

Preparing for Winter 2020 - Why you should have the flu vaccination

By Sammer Tang, Public Health Registrar, Gloucestershire Hospital NHS Foundation Trust ; Public Health Lead, College of Paramedics, Kirsty Morgan, Assistant Director of IPC, NHS England and NHS Improvement - Midlands Region

12/11/2020

 

Amid the COVID-19 pandemic, another flu season is upon on us. Every year, Influenza kills an average of 8,000 people every year in the UK. This is not your average common cold.
Influenza or 'flu' is a respiratory illness associated with infection by influenza virus. For most people, flu is just a nasty experience, but for some it can lead to more serious illnesses. The most common complications of influenza are bronchitis and secondary bacterial pneumonia. These illnesses may require treatment in hospital and can be life threatening, especially in the elderly, very young children, and people with underlying health conditions.

Why should I be vaccinated?

It’s impossible to predict the impact that flu and COVID-19 will have this winter. The common symptoms of COVID-19 are very similar to those of influenza, including: fever, cough, sore throat and fatigue, this could make differentiation between the two difficult. In addition, it is well known that frontline healthcare workers are more likely to be exposed to Influenza virus and it has been estimated that up to 1 in 4 healthcare workers will become infected with influenza during a mild influenza season, this is considerably higher than the 5.44 in 100 people in the general population1.

70.2% of frontline ambulance clinicians in the NHS Ambulance Trusts in England were vaccinated against seasonal flu compared to 75.4% of healthcare workers with direct patient contact in Acute Trusts in 2019-2020. Although this is an increase of 4.7% across NHS Ambulance Trusts since the previous year2, this is short of the ambition of the Secretary of State for Health’s ambition of 100% of healthcare workers being vaccinated, unless they have a “very good, essentially clinical reason” not to be vaccinated.

While the seasonal flu vaccine won't protect you against COVID-19, it will reduce your risk of influenza. By protecting ourselves with the flu vaccine, paramedics not only reduce the risk of spreading flu to patients and our own families, but reduce the risk of service disruption, which is particularly important throughout winter where increased pressure on services is common. There is no such thing as natural immunity against the flu virus and healthcare workers are encouraged to have their vaccine annually to ensure they are protected.

What to do next?

The year flu vaccine is a quadrivalent vaccination which contains four inactivated influenza viruses3,4. It is considered to be the best protection against an unpredictable influenza virus and has a good safety record, therefore we should all be vaccinated to protect ourselves, our patients and our families, unless there is a clinical reason not to be vaccinated. This year is particularly important for you to be vaccinated as early in the flu campaign as possible, this will reduce the burden of flu related admissions as well as ensuing that paramedics and all frontline ambulance staff are able to have the COVID-19 vaccination should it become available.

In addition to frontline healthcare workers, the flu vaccine is also offered to at risk groups, as part of making every contact count paramedics should be encouraging the uptake of vaccination in these patient groups5:

• All children aged two to year 7 at secondary school.
• Those in clinical risk groups and aged between six months and under 65 years
• Pregnant women
• Those aged 65 years and over
• Those in long-stay residential care homes
• Carers
• Those on the shielding list for COVID-19
• Close contacts of immunocompromised individuals and household contacts of those people on the shielding list for COVID-19



References

1. Kuster et. al. (2011) Incidence of Influenza in Healthy Adults and Healthcare Workers: A Systematic Review and Meta-Analysis https://doi.org/10.1371/journal.pone.0026239

2. Public Health England (2020a) Seasonal influenza vaccine uptake in healthcare workers (HCWs) in England: winter season 2019 to 2020 [Online] https://www.gov.uk/government/statistics/seasonal-flu-vaccine-uptake-in-healthcare-workers-winter-2019-to-2020

3. Tang S. & Morgan K. (2020). Seasonal flu, vaccinations and COVID-19, Journal of Paramedic Practice. 12(9): 346-348 [Online] https://doi.org/10.12968/jpar.2020.12.9.346

4. WHO (2020) Recommended composition of influenza virus vaccines for use in the 2020 - 2021 northern hemisphere influenza season [Online] https://www.who.int/influenza/vaccines/virus/recommendations/2020-21_north/en/

5. Public Health England (2020b). National flu immunisation programme plan https://www.gov.uk/government/publications/national-flu-immunisation-programme-plan

The HCPC and Paramedic Self Referral

Learning From the Past for a Better Future

24/09/2020

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. 
 
COLLEGE OF PARAMEDICS MEMBERS SHOULD CONTACT THE LEGAL HELPLINE IF YOU BELIEVE THERE IS A NEED TO SELF-REFER TO THE HCPC, INCLUDING FOLLOWING A REQUEST TO DO SO BY YOUR EMPLOYER, TO ESTABLISH WHETHER YOUR CIRCUMSTANCES WARRANT SELF-REFERRAL.  
 
For more information on Fitness to Practice self-referral and legal representation click here  
 

Author:
Liz Harris FCPara
Head of Professional Standards, College of Paramedics

Bullying, Harassment and Discrimination in the Paramedic Workplace

By Duncan Lewis, Emeritus Professor of Management, Plymouth University 

07/07/2020

 
 

HCPC Hearing: A member’s perspective 2019

A member of the College of Paramedics shares their experience of receiving a letter from the HCPC.

13/06/2019

Earlier this year I was informed of allegations against me made by a former employer. The relationship had broken down between us so no local resolution could be made. The allegations were forwarded to the Health and Care Professions Council (HCPC).

I was braced for the first letter to land on my doorstep to inform me that the HCPC had received allegations and they were now going to test the evidence to decide if a fitness to practise hearing was indeed needed. The letter stated at this time I could continue to practise unrestricted. I informed my current employer as advised in the letter. 

Nothing could have prepared me for what happened seven days later.

A second letter landed in the morning and I did not read this until the evening after I returned home. It stated that, on the basis of the seriousness of the allegations, the HCPC had seen fit to request an interim suspension order. 

I was devastated! How would I work? How would I feed my family? My reputation of 20 years would be tarnished for ever. I would be humiliated and the source of ridicule.

I contacted the College of Paramedics, of which I am a full member and have been for several years. I was not prepared for the next few minutes, hours or days.

As soon as I contacted the College, I was given names of responsible people who would support me through the process and recommended to phone the legal helpline.

I dialled and left a message. Three hours passed and I called again and got through to the legal team.

They listened for half an hour and advised me of the next step. They would have to speak to the College before confirming they could act on my behalf.

Hearing my concern, they referred me to The Ambulance Service Charity (TASC). 

No sooner had I hung up from the Legal helpline I had a call from an Advisor at TASC who turned out to be a godsend. She reassured me that they would step in and help me with whatever they could, financially and emotionally. My grief turned to shock at the kindness of a charity I had never heard of before, but they were to be there to support me and my family.

A day later I was informed that the College would provide me with legal assistance. 

I did ask myself just how they would manage this as I had only six days, including the weekend, before I had to appear before a HCPC hearing.

The phone calls and emails were coming quick and fast and involved evidence gathering and the background information needed, not to mention a CV, CPD and testimonials.

I was informed on the Monday, with 48 hours to go that the College were not only providing me with a solicitor, but also with a barrister to defend my case.

On the day of the hearing I met the team in a small room at the HCPC Tribunal Service in London and we poured over every angle of the case. They asked points that I would never have thought relevant or necessary with the result when I went to the hearing that afternoon that I felt protected, represented and heard. I said nothing but to confirm my name.

Everything that needed to be said was said by the QC representing me. The result was no interim suspension nor any restrictions in practice. The relief brings me to tears even now.

You would never go into a situation without your Personal Protective Equipment (PPE) be it helmet, hi-vis, ballistic protection or even gloves. If you are practicing in our field and you do not have the protection of OUR College, you are operating without some of the best PPE.

I thank the College of Paramedics for their swift action through which I was provided with a fantastic legal team who protected me and my family when we needed it most. 

Please join our College and strengthen it as the main voice for our profession, so that when and if you ever need them, it will continue to be the strongest support available for both defence and advancement.

Author:
Name and position withheld for purposes of anonymity

Factors affecting the retention of paramedics within the Ambulance Services

Liz Harris FCPara, Head of Professional Standards for the College of Paramedics writes a short blog based on the presentation she delivered at the Association of Ambulance Chief Executives, Ambulance Leadership Forum in March 2019 detailing the findings of a study on ambulance service retention carried out in 2016.

21/05/2019

The methodology for the study included a Literature Search, a review of several national publications and a selection of Human Resources Management texts. Specific data from four sources of secondary data was also used, including the College of Paramedics Recruitment and Retention survey conducted in 2015 (unpublished). This survey had 977 responses of which 238 were from individuals who had left an Ambulance Service in the preceding 24 months. 

Four key themes emerged that could potentially impact on an individual’s intention to leave their employment: 

CAREER AND DEVELOPMENT OPPORTUNITIES 
The College of Paramedics survey asked what would contribute towards the ability of ambulance services to retain existing staff? Improvements in career progression, training and access to continued professional development were mentioned by the highest number of respondents. The lack of training and development has two main consequences; Firstly, paramedics are leaving to pursue development and new opportunities outside of the ambulance service, which is reducing the qualified and experienced workforce numbers. Secondly, the paramedics that remain are experiencing a change to the type of workload that they most consistently experience but are not historically trained to deal with, this without any ongoing training and development is negatively affecting their confidence and job satisfaction. 

JOB SATISFACTION/WORK EXPERIENCE 
Paramedics take a great deal of satisfaction from the job that they do and are proud of the care that they can give but the intense pressure, increasing workload, including shift over-run and shift patterns also left them feeling exhausted. Mopping up was mentioned, when other areas of the NHS are struggling, the Ambulance Service always responds and attempts to pick up the pieces. This leads to a feeling of ‘lack of respect’; being undervalued. Another challenge was mentioned, that some paramedics had come to the conclusion that dealing with and coping with difficult and/or mediocre colleagues had just become a way of life and to a certain extent accepted as the way it is. It was better to keep your head down and keep off the radar that raise concerns. A move towards peer review and supportive clinical supervision that allows a safe space for positive sharing of experiences and learning would have beneficial effects on staff’s work experiences. Communication was mentioned frequently in the literature and from all the data sources, poor communication was at the top of the list for workplace features that were reported most frequently as having a negative effect on staff’s well-being.  Email communication seemed to be the preferred method used by employers, but this was not at all sufficient and there was no time for operational staff to read them. Only 12% of staff reported having good communications with senior management.

MANAGEMENT ISSUES
Lack of management support was the reason given for leaving an Ambulance Service by the greatest number of respondents in the College of Paramedics survey. Unsupportive management was one workplace feature in particular that had the most significant detrimental impact on staff well-being. Historically management within ambulance services is geared towards vocational ambulance staff that has stayed within the same service for their whole career. Now new paramedics join ambulance services directly from academic institutes, they are young and a more mobile workforce, with less loyalty towards their employer. This change in workforce represents a challenge for some existing management cultures within ambulance services. Staff reported that promotion occurs ‘through the ranks’, with a focus on achievement of performance targets not on delivering clinical quality. An additional complexity is the expanding clinical and professional context and the increasing autonomy of the modern paramedic clashing with traditional command and control management cultures. A lack of formal management training may contribute to what is perceived as inattentive behaviours of managers and a lack of employee engagement. 

PAY AND BENEFITS
Much of the Human Resources Management text discusses pay and the impact of salary on retention at length, but the evidence in the papers, reviewed within this study, specific to emergency personnel suggests that pay only becomes an issue when other aspects of the job are impacting negatively upon the individual or when job satisfaction is low. Pay, was highlighted in the College of Paramedics survey as a reason for leaving and as a potential tool for retaining existing staff. Evidence from Australia indicates that the new graduate paramedics will seek out employment that suits their professional aspirations and their personal needs such as flexible hours and adequate pay. It is therefore necessary to get pay appropriate for the role, but the benefits will be short-lived without improvements in the other three key themes discussed within this study. 

To conclude…
Job satisfaction has been high for paramedics for many years due to the nature of the work, and pride in a job means that people tend to stick with it. Now, however, it appears that the negative impact of some of the other issues are having an effect on how paramedics feel about themselves, their work, their role and their employer. Paramedics often rely upon camaraderie to reduce the innate stresses of the work but due to the increasing workload and changing work practices this coping mechanism is now in short supply. Moving from an environment where underachievement of performance targets is constantly highlighted with blame apportioned, to a culture where learning is shared and people and positives are celebrated, would greatly increase staff satisfaction and wellbeing, and potentially subdue any intention to leave. Arguably Ambulance Services have relatively little influence on the external pull factors that cause paramedics to leave but can certainly work towards reducing the internal factors that push paramedics towards the exit, in particular by investing in their staff’s wellbeing and ongoing professional development. The impact of managers on staff wellbeing and their desire to leave an Ambulance Service should not be underestimated. All the findings within this study highlight a situation that links unsupportive managers with dissatisfied staff. This is a key point, not least because supporting managers to improve their knowledge, skills and behaviours is within the capability of all Ambulance Services.

Author: 
Liz Harris
Head of Professional Standards, College of Paramedics

Stroke Mimics or Are They?

Sue Newsome shares her experience of her father being mis-diagnosed with a Stroke Mimic

30/04/2018

My Dad had a Stoke on the 15th of June 2015, a date that will be forever etched in my memory. Dad phoned me and said ‘Sue I’m scared I’m having a Stroke, I know because I have watched the adverts on TV’. ‘My vision and my balance have gone’. Dad sounded petrified and his speech was slurred. I told him I would phone his neighbour to sit with him and I would call an ambulance and then head over. I live in Stockport, Dad lived in Huddersfield. I explained all of Dad’s symptoms to the call handler and then set off to Dad’s. I arrived at Huddersfield A&E about an hour and a half after Dad’s call. I had several missed calls from my partner so I phoned him. Paramedics had contacted him to say that they didn’t feel there was any reason to take Dad to hospital as he wasn’t having a Stroke. I was shocked and phoned them as requested at Dad’s. They informed me that he wasn’t having a Stroke, I explained that I thought that he was from his description of events, but I would leave the hospital and meet them at Dad’s. This was to be my first mistake. When I arrived at Dad’s he was confused and disoriented and his speech was slurred. They asked if he always spoke like that and I explained he didn’t. They told me that Dad was FAST (Face, Arm, Speech, Time) negative despite me reiterating Dad’s earlier description of his symptoms. I explained Dad was Diabetic and they told me he had AF as they had carried out an ECG. I would subsequently find out that these were both ‘Red Flag’ indicators to consider a Stroke. I was told Dad didn’t want to go to hospital, Dad never said this to me. Can someone who is confused and experiencing a Stroke be considered to have capacity? I reiterated I thought Dad was having a Stroke several times. I was asked to stay with Dad overnight and call his GP out the next day. This was to be my second and fatal mistake. I agreed to this reluctantly. Dad’s confusion worsened, I called his GP the following morning. He came out took one look at Dad and said he wasn’t right and he would arrange for Dad to go to the Stroke Unit immediately. I drove Dad to Halifax where his scan revealed he had experienced a Stroke. This led to Dad developing Vascular Dementia and dying after 15 months of devastating declining health. 

I am aware that there is some recent research into adding Visual and Balance disturbances into the FAST diagnostic assessment and I am keen for this to be developed. Had this been part of FAST when Dad experienced his Stroke the outcome for him could have been very different.

I would also like to discuss the current trend in Stroke research. I am aware that current research patterns to identify effective Stroke Pathways are focusing on ‘Stroke Mimics’. For the majority of people and HCP’s this is a positive step facilitating effective identification and ensuring the most appropriate care pathway using accurate clinical diagnostic tools. This therefore enables the person to be conveyed to the correct hospital or Regional Stroke Unit. It ensures the most effective use of limited specialist Stroke resources. 

Conversely to balance out the effectiveness of identifying Strokes and teasing out the Stroke Mimics there needs to be research conducted into the percentage of people who are identified as Stroke Mimics but are in fact having a Stroke. What is the cost financially both to them and to the NHS for their post Stroke care.  Also, the impact on personal lives and on families from a misdiagnosis. Effective diagnostic tools are essential if these Strokes incorrectly diagnosed as Mimics are to be minimised. The FAST test is not a fool proof clinical diagnostic tool and some Strokes aren’t identified using this diagnostic criteria. 

My concern is whilst the emphasis is on identifying Stroke Mimics is there going to be an increase in missed Strokes because they aren’t identified using FAST and are deemed FAST negative and consequently don’t receive treatment at a Regional Stroke Unit. As Stroke treatment is time critical there is very little time to waste. From personal experience misdiagnosing a Stroke as a Stroke Mimic has devastating life changing consequences. I would respectfully ask all paramedics to listen to their patients experiences carefully and their families accounts. I didn’t feel that Dad or I was listened to. It was ultimately my decision to agree for Dad to stay at home on the paramedics advice. This is a decision I will bitterly regret for the rest of my life. Had Dad been taken to hospital he may have been suitable for a Thrombolysis and his last 15 months of life would not have been experienced the trauma of Vascular Dementia.
University of Kentucky. "Study supports change to FAST mnemonic for stroke." ScienceDaily. ScienceDaily, 23 February 2017. http://www.sciencedaily.com/releases/2017/02/170223202514.htm

BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): Reducing the Proportion of Strokes Missed Using the FAST Mnemonic. Aroor S, et al. Stroke. 2017. 

Author: 
Sue Newsome

I’ve seen terrible things as a paramedic. The worst isn’t what you’d expect

Liz Harris FCPara talks about the worst thing she has seen as a paramedic

24/04/2018

What’s the worst thing you’ve ever seen? Ask any paramedic and they will have been asked this question many times over in their careers. I’d never given myself time to properly think about the answer, until recently.

Is it having my fingers in the back of a teenage boy’s brain as my colleague and I lift his limp bloody body into a bag after he had flipped over his new car on a dark country road?

Is it looking upon a small, wafer thin, dead child curled up on her Cinderella duvet after drinking her parents’ medication that they use to help with their addictions?

Is it the elderly man whose closed curtains had gone unnoticed by his busy neighbours while he lay decomposing into his own carpet?

It is none of these.

My answer starts at 6.10am one morning many years ago with a callout to an elderly man who is struggling to breathe.

We arrive at a slightly neglected bungalow where a frail elderly figure limps slowly to the door and greets us with an apology – she didn’t want to bother us. Her husband is slumped in the front room. I know he is not well and he needs to go to hospital. Mavis*, the woman who answered the door, is visibly shaken on hearing this news but she finds solace in starting preparations for her beloved husband, Bert, to leave for hospital. He needs clean pyjamas and a toothbrush, and after fondly rubbing his chin, he will need his razor too.

I give Bert some oxygen and start to think that if we don’t get him to the ambulance quite quickly he will collapse. Mavis returns tearful with her husband’s belongings. I talk to her to try to convey the seriousness and urgency of the situation. Bert is stoic in his responses, telling his wife he will be fine, but he is kind too, reminding Mavis of how much he loves her. Mavis is proud, they have been married for more than 60 years, she says, as she ambles away again.

I look around the room at faded photos of many generations of their family. Bert tells me they are all dead now, even their son who died young. I talk with him and reassure him that we will be going to hospital soon. She is the love of my life, he says, between tiring breaths; there has never been anyone else. I remember his soft slow words perfectly and the telling look in his eyes – he knows he is not coming home again. I worry that we are taking too long. Bert needs to be in hospital quickly; I don’t want him to die in my ambulance.

Mavis is elderly and frail herself, and accompanying her husband to hospital isn’t an option. I worry there is no one to come to help her when we are gone. My haste to get Bert out of the door and to hospital is abruptly subdued by the realisation that this is most probably their final moment together; they are about to say goodbye to each other for the last time.

I try to convey the gravity of the situation to Mavis. I think she finally understands when her eyes fill up. She limps back towards Bert, who is still protesting to her that he will be fine. Her hands cup his cheeks as her small stooped frame leans forward to give him a kiss. I pause momentarily, trying to be invisible, and then ask quietly if we can go. Mavis delicately flattens Bert’s hair to one side of his head, smiles at me and nods her head. I ask Bert if that is OK and he smiles and nods too.

Bert died later that day and I spent a lot of time wondering what happened to Mavis. I knew that I had cared for Bert and looked after him well, but I had deserted Mavis, I had left her all alone. I toyed with the idea of visiting her to check up on her. This felt right in many ways, but wrong in others too. I didn’t know what to do. I had prioritised Bert’s care but in doing so neglected what Mavis needed. I was left feeling I had failed her in many ways.

When thinking about my answer to the “What’s the worst thing you’ve ever seen?” question it didn’t take me long to remember this job, even though it happened many years ago. It is the job that I most agonised over. It is the job that stayed with me for the longest time after it was over. You might think it can’t be the worst thing I’ve ever seen, but it is definitely the worst thing I’ve ever felt.

I never did go back and check on Mavis.

Author: 
Liz Harris
Head of Professional Standards, College of Paramedics

Paramedics Need Degrees? Why?

Richard Taffler MCPara discusses whether paramedics need degrees.

06 04 2018

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
• Administration
• Research
• Senior Lecturer
• Health and Safety
• Prison Service
• 111 Clinician
• Management
• 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 . . . 

http://www.nhsconfed.org/resources/key-statistics-on-the-nhs
https://www.nmc.org.uk/globalassets/sitedocuments/other-publications/the-nmc-register-30-september-2017.pdf
https://www.nmc.org.uk/about-us/reports-and-accounts/registration-statistics/
https://www.collegeofparamedics.co.uk/publications/post-reg-career-framework [insert link]
https://www.collegeofparamedics.co.uk/publications/post-graduate-curriculum-guidance [insert link]

Author: 
Richard Taffler MSc BSc(Hons) BEng FASI MCPara


People Like Us?

College of Paramedics Executive Officer, Liz Harris takes a look at the recent HCPC 'People Like Us?' report and considers why so many paramedics self refer.

28/02/2018

Why does the paramedic profession have a disproportionately high number of HCPC fitness to practise cases against it when compared to the numbers of paramedics on the register? The ‘People Like Us?’ report was produced following research commissioned by the HCPC in response to several years of high numbers of fitness to practise cases against paramedics. In 2016-17 paramedics made up 7% of the Register and 13% of fitness to practise cases. You may think that these individuals are exceptions within the profession, that they differ in terms of their motives or behaviours but in fact they are just like us. They are people like us. The vast majority of referrals where ‘one offs’, did not result in any harm to a patient and only 18% of referrals came from complaints from the public. Public perceptions and changing expectations were factors highlighted in the report as reasons for referrals. These factors are also linked to the nature of paramedic practice, paramedics deal with people in crisis, at their most vulnerable time and in unpredictable situations.  

In the sample within this research, 46% of the HCPC referrals came from self-referral compared to an average of 26% across all 16 professions. 84% of the paramedic self-referrals resulted in no further action by the regulator. These figures suggest that the disproportionality highlighted in this research originates from a high number of self-referrals that do not meet the HCPC standards of acceptance for an allegation, rather than an indication of clinician impairment of competence. This statistic is at first sight welcoming, but on deeper consideration it is clear that a HCPC referral, whatever the outcome is most probably significantly psychologically distressing for the individual and their family.

It is important for us to remember the history of the paramedic profession when discussing the findings within this report. The professionalisation of paramedics began to occur following introduction of registration. Regulation of paramedics by the Council of Professionals Supplementary to Medicine began in 2000 (and subsequently by the then Health Professions Council (HCPC) in 2003. This regulation fuelled the formation of the paramedic professional body, the British Paramedic Association in 2001 with a name change to College of Paramedics in 2004. This situation is unlike some of the other professions regulated by the HCPC who had already established their professional status during many preceding years. 

In the early years of registration, paramedics were not prepared and fully informed of the processes and consequences of professional regulation. This combined with the effects of the cultures highlighted within the report has led to consequences that have perpetuated over the years and are still apparent today. These consequences are detailed in the full report through narrative accounts from working paramedics describing ‘fear of the HCPC’, a ‘big stick’ approach by Ambulance Services to tackling issues and complaints with the threat of ‘you better self-refer or else you’ll be struck off’ ringing true for many in the profession. These accounts point towards a notion that the paramedic profession could have had a much better relationship with the HCPC if Ambulance Service culture had been different. 

Ambulance Services could increase their support for paramedics in several key professional areas; complaints and investigation processes are a notoriously difficult time for paramedics to navigate, access to all appropriate documentation and expert statement writing guidance is vital; fitness to practice processes can be long and arduous and impact negatively upon the individual’s confidence; continuing to work whether under sanction or not can be clinically, ethically and emotionally very challenging; any clinical development following a return to practice must be robust and effective. Adequate professional and psychological support for paramedics and other frontline ambulance clinicians must make its way right to the frontline where it is needed most.  

The College of Paramedics welcomes the findings within this report and thanks the HCPC for its commissioning. Not only because now the situation is highlighted through a robust piece of research, we can look to understand the complex reasons and begin to educate to dispel the myths that still prevail and work towards reducing the number of unnecessary self-referrals that paramedics make. This report marks a moment in time to move away from what prevailed before and towards a different and much better relationship with our regulator and the employers of paramedics. The findings and recommendations should also provide further impetus for ambulance services developing more positive and transparent approaches to clinical issues and complaints with patient safety and professional learning at the core of any investigative process. 

Should you have any further questions or suggestions on how to tackle some of the points highlighted please email liz.harris@collegeofparamedics.co.uk 

Author:
Liz Harris, Head of Professional Standards, College of Paramedics

Flu jab: it’s about doing the right thing, right?

College of Paramedics Executive Officer, Liz Harris reflects on why some paramedics are deciding not to receive the flu vaccination.

18/01/2018

I have not been quiet recently about my opinions on the flu vaccination, I’ve promoted its benefits through social media, the College of Paramedics INSIGHT magazine, spoke about the potential consequences of not having the vaccination at the Emergency Services Show and facilitated vaccination opportunities for attendees at several recent CPD events.  

I also feel that I can’t remain quiet either on some of the responses and attitudes I have heard whilst doing all this. The responses look like this…‘It might make me ill and I’ve had too much time off sick already’, ‘I’m not having the flu jab in my own time, I’ll wait until I can get out of getting a job’, ‘I’m not helping the service get a load of cash for hitting targets’, ‘If I get the flu that’s alright cause it means I can go off sick then’. All of these reasons leave me uncomfortable and are difficult to digest, arguably for different reasons but do they highlight a prevailing culture that is not beneficial for staff wellbeing and patient safety. 

As registered health professionals, paramedics have a professional obligation to keep themselves healthy and their patients safe. For me, that means contributing to the reduction in the spread of a (to a certain extent) preventable infectious disease that kills thousands in the UK every year. There are good reasons for not having a flu jab but I have not heard any of these voiced recently and they are certainly not those I mention above.

These responses are unpleasant at best and at worst, corrosive. But they are a reflection of a culture that historically has not supported staff to develop, learn, achieve and inspire. I look forward to a time when the behaviours highlighted in the responses above are a thing of the past along with the command and control culture through which they were born, and a time when all ambulance services can achieve flu vaccination uptake numbers to rival the best NHS hospital trusts.  

Author:
Liz Harris, Head of Professional Standards, College of Paramedics

My experience of receiving a fitness to practise concern

College of Paramedics member Rebecca Connolly MCPara shares her experience of receiving a fitness to practise concern.

26/06/2017

 

I have been a member of the College of Paramedics since 2013 and had little cause to use their insurance protection until 2015 when I received a HCPC fitness to practise (FtP) concern.

I’ve been a paramedic for four years, I’m proud of the job I do – and I’m good at it.  I pride myself on delivering exceptional clinical care and so to receive notification of the concern was a huge blow both professionally and personally.  I remember receiving a large parcel through the post with the Health and Care Professions Council (HCPC) logo on – I immediately knew it couldn’t have been good.  When I opened the parcel, there was a letter from the HCPC detailing the concern with all their evidence attached.  I didn’t receive an initial letter as some people do and it was like I’d been punched in the stomach. The crippling sense of nausea and fear was something that will remain with me. The contents of the HCPC’s letter and evidence was presented in such a formal and legal way, completely unexpectedly that I immediately felt guilty without even being given the chance to defend myself, against what appeared to be a malicious allegation.  I felt utterly vulnerable, and it honestly felt like I was on a criminal trial.

I started to try and put together a plan to deal with it and so contacted the College of Paramedics in relation to their FtP insurance.  Following the completion of a claim form I was directed via Abbey Legal to Andrea James of Knights 1759 firm of solicitors.  From the outset she reassured me, took everything on board and took full ownership of my case.  This was a hugely reassuring step because I didn’t feel so alone.  I still felt massively vulnerable due to the number of unknowns – we all want to remain in practice and so the mere possibility of being struck off remained with me every day.

She took the time to set up a meeting and asked me lots of questions, detailing my side of events, what happened and why.  My case was unusual in some respects but she formulated a detailed plan and confirmed that she could take my case for me.  From that point, I had little contact with the HCPC as everything was completed vicariously through her – and this was brilliant.  She advised me to continue to work as normal and try not to worry too much.  

During this period, I was asked to collate various pieces of information for them and obtain character and clinical references that would form part of the response to the Investigation Committee.  I was informed of everything every step of the way and I believe that Andrea – who is a partner at the law firm – went out of her way to keep in contact and reassure me.  The fact that she was my point of contact was a great relief – it wasn’t passed to a junior member of staff and I was never passed from pillar to post.  Any questions were answered expediently and nothing was too much trouble.  She appointed an expert to produce a report for me and all this was covered by the College’s standard insurance cover, which is part of full membership. 

Following the Investigating Committee meeting in early 2016 it was found that the case would proceed to a hearing and the HCPC’s rationale baffled both myself and the solicitor in that the presumption of guilt was evident from the outset with no regard to expert evidence submitted.  This was hugely stressful and I found that I lost further confidence in work – any letter that came for me was immediately met with panic attacks, I was so worried and it permeated into every aspect of my life.  When you’re passionate about the job, and genuinely care about doing it well, the thought of losing it has perhaps been one of the most stressful experiences of my life.

It was some relief to know that I was fully supported by my legal team, which at this point included Andrea and a very well-respected QC who was appointed to represent me at the hearing.  Another two experts were also appointed to conduct reports in preparation for the hearing.  The HCPC has guidelines and standards about times of hearings etc but mine took ages – well over a year.  This year was hell, and I don’t use that word lightly: I couldn’t apply for jobs as I had to declare the ongoing investigation which precluded me from most.  I was stressed about it, I lost sleep, remained anxious at any letter coming – in fact I remember receiving a letter from the HCPC to which I had a full-blown panic attack, and all it contained was arbitrary information about some changes they were making.  I lost so much confidence in my ability, and I was so worried about receiving another FtP issue.  I felt I was an awful clinician, that I would lose my job and that my life was essentially over.

By this time, I had got to know Andrea quite well, and she me.  I felt that she was personally invested in helping me professionally.  I genuinely felt like she wanted to do her best, not for anything other than because she cared.  This meant a huge amount to me and something for which I’ll always be grateful.  Both Andrea and the QC were very honest and upfront about potential outcomes and what would be reasonable etc and so I was never left in any doubt as to what was at stake – this is important for helping come to terms with it.

Eventually the hearing date came about, over 12 months following the Investigation Committee meeting.  By this time, I was quite looking forward to it: I just wanted it done and dusted so whatever happened I could move on with my life.  In the meantime, I had continued my work as a paramedic and obtained several commendations, so I knew that in any case I had done my best.  Every time I got frustrated at a late finish or something, I reminded myself that my job, my vocation was in jeopardy and I should be thankful that I could do it.

The hearing itself was extremely well organised and I cannot fault the HCPC in any way.  It was impeccable and fairly run.  Everyone was polite and the HCPC’s Presenting Officer was fair and decent in the way she presented her case.  The hearing was scheduled for three days but lasted for only two as the panel decided the allegation was not well founded.  This was a HUGE relief and something I’m still coming to terms with – over two years of stress had been resolved.

I cannot express in words how grateful I am to the College of Paramedics and to Andrea and her team at Knights 1759 who worked tirelessly to bring me the outcome I felt was warranted.  It would not have been possible had it not been for my membership of the College of Paramedics as the total fees I believe were likely in the region of £20,000 from start to finish.  I genuinely cannot imagine going through the process I’ve gone through without that professional support. 

I still get nervous when the Royal Mail van arrives outside my house, and any letter or email from the HCPC sends me panicking – it probably will for a while yet.  I still lack confidence in my practice and worry about decisions I’ve made long after I’ve made them.  The effects from my experience will stay with me forever, but I’m thankful that I’ve had them.  The experience with the HCPC has been mixed in that I felt ignored and presumed guilty from the outset, but from the Investigation Committee result onwards I can’t fault them.

I wanted to write this for many reasons:
1.    To express thanks and gratitude to the team of professionals who helped me, and to thank my colleagues and friends who submitted wonderful references;
2.    To try and offer some support to paramedic colleagues who may be going through the FtP process;
3.    To try and give more information about the hearing itself as to what happens, to provide reassurance;
4.    To urge every paramedic who reads this to join the College, if not already done so.  It is absolutely worth the £9.00 monthly fee, if only for the FtP insurance.  

The support I received far exceeded expectations.  The College were wonderful in dealing with my initial enquiry and the process felt built to help and support me.  We as a profession need to support one another and can only do this with the strength of one voice provided by the College of Paramedics.

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Read the Blog: 10 Things you should know if a concern is raised about your fitness to practise

10 Things you should know if a concern is raised about your fitness to practise

The Health and Care Professions Council (HCPC) provides a list of 10 important things you should know about the process and the support available if you find yourself the subject of a fitness to practise allegation.

23/02/2017

 

1. The fitness to practise (FtP) process is not designed to punish registrants for past mistakes.

Rather, the process is designed to protect the public from those who are not fit to practise. Finding that a registrant’s fitness to practise is ‘impaired’ means that there are concerns about their ability to practise safely and effectively. In 2015-16, only 1.07 per cent of paramedics were subject to an FtP concern; a very small percentage, indicating that the vast majority of registrants are practising safely and effectively.
 
2. What do we do when we receive a concern about a professional on our register?

We consider each concern individually to decide whether it meets the standards of acceptance. This is the level a concern about a registrant must meet before we will investigate it as a fitness to practise allegation. We may make further enquiries to help us make this decision. If we find that a concern does not meet the standards of acceptance, we will close the case and take no further action. In 2015-16, of the 239 concerns raised about paramedics, 162 cases were closed because they did not meet the standards of acceptance.

3. Your case will be allocated to a case manager.

If the standards of acceptance are met, and you find yourself the subject of a fitness to practise allegation, the case will be allocated to a case manager, who will remain neutral. They can explain how the FtP process works and what panels will consider when making their decisions. However they cannot advise you what to include in your response or how you should represent yourself.

4. We will give you an idea of how long our enquiries will take.

We understand that it can be stressful when an FtP concern is raised, and we will provide you with an idea of how long our enquiries will take at each stage of the process.

5. You can respond to the allegation in writing within 28 days. It is important to engage with the process so that you can give your side of events.

Once we have all the information we need, we will write to you with full details of the allegation that has been made plus copies of the documents we have collated. You are then invited to respond in writing within 28 days. If you need more time, your case manager can offer a 28-day extension, and if further time is required you can make a written application to the panel. 

6. You may find it helpful to get advice from your professional body, The College of Paramedics, your union, or a solicitor at the earliest opportunity.

They will be able to provide advice on what to include in the response to the allegations which will be provided to the Investigating Committee Panel.

7. You are entitled to be represented throughout the process.

If the case is referred to a hearing, registrants are entitled to be represented, or can represent themselves, throughout the process. Information and guidance on the fitness to practise hearing process is available on our website, and explained in this useful YouTube video.

8. Cases are scheduled up to four months before the actual hearing.

We try to give registrants at least 60 days’ notice of the hearing date. We will also give you the material that we plan to rely on at the hearing 42 days beforehand. We ask registrants to provide their material 28 days before the hearing date.

9. Details of the hearing and allegations are published four weeks before the hearing is due to start.

We put this information on our website as the hearings are held in public. We do not put the information on the website more than four weeks before the hearing date to make sure we are acting fairly and balancing your rights with our role of protecting the public.

10.  What are the possible outcomes of a final hearing?

If a registrant’s fitness to practise is found to be impaired, the final hearing panel will decide whether a sanction should be imposed. They may take no further action; caution the registrant; make conditions of practice that the registrant must work under; suspend the registrant from practising; or strike their name from our Register. Before making their decision, the panel will carefully consider the circumstances of each case and take into account all that has been said in the hearing. It is important to remember that the purpose is to protect the public and not punish registrants.

For more information about the FTP process download our brochure ‘What happens if a concern is raised about me?’ or visit our dedicated FTP pages http://www.hcpc-uk.org/complaints/resources/

Further information about the work we do in considering allegations about the fitness to practise of our registrants can be found in our Fitness to practise annual reports http://www.hcpc-uk.org/publications/reports/

Author
HCPC

Stress in the sector: A member’s perspective

Adrian McGrath MCPara from Northern Ireland discusses perceptions of stress in the current paramedic role

23/01/2017

 

My dream was to be a paramedic back then, in those days we lifted stretchers into ambulances as the troubles in Northern Ireland alerted my colleagues to something gut wrenching minutes away. Where casualty departments inspired me as I saw consultants and young doctors being taught and managing in a timely fashion the sick trauma or medical patient that had just came through the door. Inspiration is a little harder to come by these days in that context. I achieved one of my dreams and I've probably grown, matured and absorbed what I could over the years. Currently, stress has a strong penumbral edge to it, as the wide measure of society and its illnesses and those increasing accidents of life demand our skills and energy on a much larger scale than what was needed in the past, with fewer resources. So where do we (I) go from here?

Personally, stress can subtly tease out the unseen good or hidden ability in us, where that propensity to overcome and to adapt to unforeseen situations (or delayed time) on scene enhances one’s ability to cope. However, that said, there’s a fine line in that sticky medicine of service and self-balance, whilst caring for another in that acute phase of trauma or illness. To be your best you have to feel your best. This only comes from re-energisation of the self with careful gentleness in how you approach the busy mind, the mind which most likely has seen something nasty, as the sensory and visual response post-shift kicks in. This is a necessary quality we must fulfil and master, in order to live a long, mentally healthy and purposeful life, whilst we work on that escalator of fuelled adrenaline at times! I've considered a complete alternative to this new era and changing face of the pre-hospital world I inhabit...thou that is yet to be decided! However, there is something honest and pure in being able to help another in their hour of need...so time will be my judge on that decision.

There is no quick fix here, the system is fractured and continually fracturing; and like any spiral fracture it can take a long while to heal itself, but undoubtedly it leaves its mark and weakness creating a fissure upon the system. My colleagues, who I admire give 100% everyday as they travel the highways and byways carrying out life-saving procedures at times whilst on route to hospital, whilst interacting with that multidisciplinary team of professionals we encounter each day; for that one, or perhaps multiple casualties we have to treat on the roadside, or in the various communities that we are invited into. The system is impinging on us and our response, in my opinion, is that we must be more visceral in how we react to this demand upon our physical wellbeing; and to recognise when we need to nourish the body as well as the soul, through our shared experiences, recognising when we need genuine time out. In order to carry on providing that cutting edge professionalism we offer to our patients.

We've got to try to hinder ourselves from becoming attached to that second victim syndrome, through that loading dose of stress which may be unresolved from previous calls, due to demand, or from re-living a terrible incident, where perhaps lethargy, mental fatigue or negative self-worth spirals our thought processes in these difficult, challenging and demanding times that we find currently ourselves in.

Maybe the periscope with how I see the world may need a new optic to recast and renew a fresh inspiration for me, as this New Year offers me its blank canvas of invitation and surprise. Other crises when one looks back into the history of turbulent times, would perhaps suggest at that time they also had to deal with such challenging structures of change in their communities, in accessing their necessary social or health needs; for life is merely passing through us and the only inherent gift we all have is to be resilient and kind towards our toughest challenges, to meet and filter stress with a fresh objective whilst we look after ourselves and each other, the best we can in these challenging times...

I don't want to lose any of my colleagues to terminal burnout or something even worse…

Author
Adrian McGrath MCPara, Paramedic, Northern Ireland

HCPC Hearing: A member’s perspective

A member of the College of Paramedics shares their experience of receiving a letter from the HCPC.

07/12/2016

In 2015 I made one of the best decisions of my career when I joined the College of Paramedics. If you’re not already a member, I urge you to do the same; you never know when you might need them.

I became a paramedic in 1996 after a distinguished career in the army. My 20 years’ experience includes specialised training, mentoring, and leadership roles with organisations as diverse as the Helicopter Emergency Medical Service and the London Ambulance Service. I’m also a previous winner of the Allied Health Professional Worker of the Year Award. 

As a paramedic, you dread the Health and Care Professions Council (HCPC) envelope dropping onto the doormat, especially when it’s not renewal time.

I remember it vividly. It was a bright and sunny morning when it came through, the gleam of the white envelope imprinted with the HCPC logo stood out on my dark and dusty doormat.

The hairs on the back of my neck stood up, ‘hmmm HCPC’ I thought, ‘what do they want from me?’

I carefully peeled back the envelope and withdrew the letter. As I slowly read through I realised my worst fears had come true, it was a complaint about my fitness to practise.

The wording of the letter I found quite petrifying; terms and phrases that were alien to me that I found quite intimidating given the situation in which I now found myself. I felt extremely vulnerable and quickly formed the impression that I had a guilty verdict hanging over me without even having been able to put my side of the story. What felt worse was it appeared they’d taken months to prepare the case and I had only seven days to respond.

As I took a step back, the magnitude of the accusation dawned on me. This one thing could ruin my career, which would also have a devastating effect on my family.

I sat on the bottom of my stairs, with my head in my hands wondering what on earth I should do next – ‘Where do I start? How do I start?’

As I sat there contemplating life, I remembered as a member of the College of Paramedics I receive fitness to practise insurance as part of my full membership.

I nervously picked up the phone and made the call to the College and was greeted with a supportive and sympathetic ear at the end of the phone who quickly calmed me down. I was advised to call the insurance company to lodge my issue. I called them straight away and again, I was greeted by a very friendly and supportive person. Whilst on the phone they sent me a simple form to fill in via email, which I sent straight back. I soon received a phone call from the legal team providing excellent advice and reassuring me that they would handle everything. Their first job was to contact the HCPC with a strongly worded letter for an extension to the time-frame they had given me to respond, which in their opinion as well as mine, was unreasonable. They also informed the HCPC that they would be handling my case, which took a huge weight off my mind.

I was given a list of things they required and a number at which they could be contacted on. This number was always answered, I was never fobbed off and if in a meeting they always called me back.

Both the solicitors and the College were excellent in providing support and guidance and keeping me informed at every step of the way. The solicitor put everything together and assured me that my case wouldn't even go to a hearing, they were surprised it had even got this far.

The file was duly sent and only four days later we received a reply of ‘no case to answer’. This was great, however, the whole process had taken eight months to conclude. The College and the solicitor were fantastic. I cannot thank them enough. For less than £10 a month, the support I received was second to none and I would strongly advise any paramedic to join the College, not just for the insurance but for the support of having someone at the end of a phone.
 
The views expressed in this article are made by a member of the College of Paramedics. 

 
Disclaimer
The opinions expressed by the various contributors are not necessarily those of the College of Paramedics. The inclusion of a blog does not necessarily imply recommendation of its aims, policies or methods. The College of Paramedics will not be liable for any errors or omissions in this information nor for the availability of this information.