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
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
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
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
Evidence based
Clinical Management Plans
Patient Group Directions
for any treatments in
these plans
Clinical Management Plan
for
Gastroenteritis
CMPs are developed by
Paramedics + GPs.
Approved through
SECAmb NHSFT
governance
processes
Inter-professional model of
Learning and Teaching
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 (MiniCEX)
• 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
The Paramedic Practitioner Curriculum PCTs Surrey, Sussex and Kent,
Framework, Rationale and
Royal College of General Practitioners
Competences Document
Patient Representation
PARAMEDIC PRACTITONER PROGRAMME
Minor Illness
Minor Injuries
Paediatrics
Elderly
Psychiatry
GP Practice Placement
Nature of
physical
Assessment
Return to Study
Psiam
Clinical Pharmacology
Decision
and
Making Therapeutics
Operational Consolidation
Walk in / Urgent Care Centre
8 weeks (26 days backfill) 7 days
per week rota
GP surgery Mon to Friday
WIC Saturday and Sunday
Timed as required waiting to return to GP practice
(extracted 36 days)
Clinical Secondment can respond to
local Cat A if free.
Working in Operations
Minimum 6 months Maximum 10
Completed prior to joining GP surgery
Total 20 weeks 45 academic points
Pass required to enter next stage
Clinical 2 weeks
Working in Operations extracted 1 day
week for 18 weeks
GP Practice Placement including final assessments
Total timeframe 120 days over 18 months
(Each day 12 hours)
KEY
HEI Module
GP Placement
8 weeks (26 days backfill) GP surgery Mon to Friday
Walk in Centre
Consolodation
Clinical Secondment can respond to local Cat A if free.
Timeframe and
extraction
Area of working
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
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
SHA Steering Group
agree :
·‘Fit for purpose’
examination
·PMETB principles
·Develop Train the PP
Trainers
·Seek RCGP quality
assurance
Blueprint of curriculum for
Exam design:
•Applied knowledge test:
•130 item MCP [SBA] format
•Clinical test – 12 station OSCE
•Workplace based assessment
in GP training practices :
• GP trainers and SECAmb PP
tutors
Quality Assurance from St George’s Hospital
Med School, RCGP, College of Paramedics
•Train SECAmb PPs in test writing & examining
•Standard setting [pass / fail]
•Simulated patients
•Conduct of examination
•Statistical analysis
•RCGP accreditation
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.