1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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