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

2. 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

3. 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.

4. 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.

5. 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.

6. 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

7. 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?

8. 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

9. 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.

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

11. 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

12. 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

13. 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.

14. HEKSS pilot PP placement programme
Evaluation Report
Prof Annemarie Rushton

15. 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

16. 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

17. 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

18. 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.

19. 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.

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

21. PP Exam – RCGP accredited

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

23. 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.

24. 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.