Pat Coleman, Suzanne Mason, Colin O’Keeffe, Jon Nicholl, Richard Edlin The effectiveness of Emergency Care Practitioners (ECPs) within existing models of care in England Pat Coleman, Suzanne Mason, Colin O’Keeffe, Jon Nicholl, Richard Edlin

Background Policy Patient-centred NHS New and flexible ways of working across organisational and professional boundaries in urgent care Maximise effective use of health care resources Projects – led by Suzanne Mason National evaluation of ECPs Phase one - early development 17 pilot sites Phase two - ‘case study’ approach 3 sites Service delivery and ECP workforce issues – in progress 19/11/2018 © The University of Sheffield

Aims of evaluation describe the contribution by ECPs to the delivery of urgent and unplanned care identify the opportunities and challenges to ECP working in different health settings examine cost efficiencies refine the methodology to inform future evaluations of service development 19/11/2018 © The University of Sheffield

Methodology Controlled observational study of ECP working in 3 different health settings in England and matched control sites without ECP working Costs study Qualitative telephone interviews with a purposive sample of ECPs, other health professionals, and managers in the 3 ECP sites Poster 19/11/2018 © The University of Sheffield

Qualitative process 3 different health care settings in England with ECP working 16 telephone interviews using a semi-structured interview schedule – 3 participant staff groups 6 ECPs 5 Other healthcare providers – GPs, nurse consultant, paramedic, nurse practitioner, clinical lead 5 Other stakeholders – strategic, operational, managerial roles Framework analysis – emerging themes layered by ‘group’ and ‘setting’ 19/11/2018 © The University of Sheffield

Opportunities? Retaining trained clinicians in the NHS New clinical pathways widening choice Benefits to other NHS staff and organisations Shared experience of new ways of working Influencing changes in all settings in how services are delivered for patient benefit 19/11/2018 © The University of Sheffield

New career pathways? “it used to be that you became a paramedic and that was it unless you went into training school to teach or into management which meant you weren’t really dealing with patients…..” ECP setting 2 “….now it’s like a huge step forward, that when you’re confident and happy or perhaps had enough as a paramedic you can step over onto the ECP side…it’s a developmental role” OHP setting 1 “what ECP does for people is for them to develop their skills and heighten their position through the clinical route…and it’s opened a new avenue..” Stakeholder setting 3 19/11/2018 © The University of Sheffield

Spin off benefits? Organisational Other staff Other staff “We have run a trial on spine clinics…for the ECPs but actually it has been very very beneficial for all the crews….very very effective…we’ve reduced the numbers that we’ve thrown on spinal wards or run into A&E unnecessarily “ Stakeholder setting 3 “I can learn loads off them. I just keep quizzing them with questions…” OHP setting 1 “how about if we get a practitioner [ECP]?” Ooh yes… those are the guys in blue, oh that’s great then they [the patient] can stay at home…” Other staff Other staff Patients and carers 19/11/2018 © The University of Sheffield

New ways of working? Inter-professional and cross-boundary working ECPs receiving calls direct from GPs, also residential and nursing homes Setting 1 ECPs working ‘in hours’ and accompanying GPs to extend ECP experience of the diversity of primary care presentations and interventions Setting 2 On going theory and practice rotating in ED and mobile units allowing nurses and ECPs to provide mutual support Setting 3 Inter-professional and cross-boundary working 19/11/2018 © The University of Sheffield

Challenges? Weak clinical and managerial partnerships Lack of understanding of the potential value of ECPs to the health team Limited numbers resulting in the ECP resource being spread too thinly ECP skills not being utilised fully Different support and supervision according to previous background and setting Variations in training and experience potentially limiting the transferability of ECPs between Trusts Where ECPs may be utilised to most effect Funding 19/11/2018 © The University of Sheffield

Recruitment? Selection of candidates was ‘crucial’ “It was about recruiting people that were happy with change, happy to challenge…the pioneers basically. ….people that were comfortable with uncertainty.” Stakeholder setting 1 “I think the frustrations grow, …there have been a couple who have left and felt that it wasn’t for them for whatever reasons….The core that are [still here]…they’re all really good.” Stakeholder setting 2 “you’ve got to realise that it is all out of hours and Bank Holidays that you’re asking people to work….” OHP setting 2 19/11/2018 © The University of Sheffield

Partnership working? Leadership Teamwork “We’ve had an excellent relationship with all the organisations involved…that has been crucial…the reason we’ve got such great engagement has been the clinical leadership….all those other organisations…also managerially” setting 1 stakeholder “They’ve got the whole team, mental health, occupational health, all sorts of additional people that if they [ECPs] see the need, because they actually get to see the patient in the home, they can refer them direct from there….” setting 1 OHP Teamwork 19/11/2018 © The University of Sheffield

Support and supervision? “I think the ability for nursing staff to transfer to pre-hospital is not as easy as it is for paramedics to go into a hospital” OHP setting 1 “It’s all a matter of experience… I mean if you have a newly qualified GP or a registrar or something…you don’t send them out and you don’t want them to be unsupervised. It’s not fair on them and it’s not fair on the patient…. and as you’re the one supervising, it’s probably not fair on you either.” OHP setting 2 19/11/2018 © The University of Sheffield

Integration and acceptance? “Some people see it [change] as a threat, some people see it as ‘thank goodness for that [ECP], it saves me doing that job’” Stakeholder setting 3 “It’s like when paramedics first came out… there was some inter-health care professional rancour but it’s probably a lack of understanding…” “Time really but also education… don’t go quiet on us - do put out memos and newsletters” OHP setting 1 “sometimes when someone is asked to do something…they haven’t the confidence to say ‘no’, and you don’t know that individual so you tend to err on the side of not asking” OHP setting 2 19/11/2018 © The University of Sheffield

Future directions “I don’t think any service really is 100% sure of how to use the ECP role to its most effect” Stakeholder setting 3 Uncertainty about where the ECP role is most effective remains Unequivocal commitment to the future of ECP working Building strong local partnerships between Trusts to maximise use of skills Benefits of team working Focus on issues of continuing professional development and transferability of ECP skills between settings Understanding that the support necessary for ECPs to contribute fully to the health care team may vary between settings and previous clinical background and experience 19/11/2018 © The University of Sheffield