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

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

The Paramedic Practitioner Programme 2 Working towards co-ordinated care with community services Competency based Curriculum Based on clinical knowledge and skills development For selected Paramedics- a 14 month pathway Devised by SECAmb following review of ECP (Emergency Care Practitioner) programme, currently taught at St George’s Congruence with DoH NHS strategy 2005 DOH report Taking health care to the patient Peter Bradley London ambulance chief exec.

The Paramedic Practitioner Programme 3 Programme development: 2 year workplace based programme pilot Roll out in KSS GP Training Practices Evaluation Collaborative development of Curriculum document Recruitment and implementation Current ‘experienced’ Paramedics Future career pathway for graduate Paramedics Booklet of competencies, and blueprint put together with st georges matached PP with Physicians assistant. Academic writing etc before modules. Origonally gp placement part way through but more effective if completed all modules before going to GP placement, banding changes within the training after half of modules and they become autonomous practitioners.

The GP Placement Content 1 Acute presentations in GP in Primary Care: working in different environments clinical assessment, management, communication, continuity of care wide spectrum of presentations Consulting skills: GP models vs traditional medical model Clinical examination skills: beyond traditional paramedic training Peviously PP would have been taught using traditional medical model.

The GP Placement Content 2 Treatment skills: suturing, minor abscess drainage, appropriate medicine management using Clinical Management Plans (CMP)s & Patient GroupDirectives (PGD)s, ‘The paramedic as the drug’ (after Balint) Team-working in primary care teams Familiarisation with GP IT systems Introduction of the Generalist Role

Teaching and learning Time table for 2 months 37.5 hr week (vaiable) Induction to whole team, building relationships, understanding roles. Tutorial weekly (link with case based discussions), time for assessments Needs assessment Staged progression as with GP STs, initial observation/joint/independent practice Bag? Who is responsible what equipment they need. At some point do flip chart exercise on what should be in bag?

Clinical Management Plans Patient Group Directions Evidence based Clinical Management Plans Patient Group Directions for any treatments in these plans Eg Respiratory LRTI Asthma Hyperventillation, Mental health Panic/anxiety attack/ depression see handouts with contents in pack

Clinical Management Plan for Gastroenteritis CMPs are developed by Paramedics + GPs. Approved through SECAmb NHSFT governance processes Again will print out and have in pack.

Inter-professional model of Learning and Teaching Similar to model for gpr

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

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

PARAMEDIC PRACTITONER PROGRAMME Return to study, learning how to learn referencing critical analysis, Psiam computerised system to aim triage, and custody police work custody paramedics. 36 hr week when in GP practice. Can get them to do what is appropriate. Gold standard has slightly changed, minor injuries and minor health now early.

HEKSS pilot PP placement programme Evaluation Report Prof Annemarie Rushton

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

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

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

Evaluation Recommendations Streamlining workplace based assessments Calibration for supervisors [ST3 & other GPs] Clearer introduction / induction guidance Potential benefits for hosting PP students Business case to training practices Selection / screening less appropriate PPs Poor team-working, poor assessment skills For future need to ensure calibration, perhaps trainers workshops to review progress of PP and calibrate re assessments.

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

PP Exam Development Mcp multi choice paper, sba single best answer

PP Exam – RCGP accredited

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

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

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