2014-19 Business Planning Template (QIPP, Cost Pressures, Integration
Transformation Fund)
Name of
Initiative
Community Paramedic Practitioners
Benefit type
Cost avoidance / Patient experience / Primary Care experience /
Ambulance service experience
High level
description of
Initiative
The primary role of the Paramedic Practitioner is the delivery
of unscheduled (urgent and emergency) care to patients,
integrated with primary care and based in the community, by
an appropriately trained health care professional.
CCG priorities
Transforming the community system.
Description of
how meets CCG
priorities
Provides care closer to home
Reduces Non-Elective admissions
Integration of community services to help provide seamless
service closer to home
Improve productivity within primary care
Improvement to local 999 red call performance
Confirmation of
how addresses
ITF priorities
Joint assessments and accountable lead professional
Lead GP
Member
Dr Charles Parker
Integrated
Commissioning
Board priorities
Improving quality of care / Improving patient experience / Working
more effectively across services boundaries / Improving health
and wellbeing
Lead Manager (+
email)
John Darley (john.darley@nhs.net)
Size of net
financial benefit
£0
Overall description/scope
As the dynamics of the NHS change the realisation that our A&E departments and
hospitals are under ever increasing pressure to cope with the increased volume of
patient attendances we need to actively seek out new strategies (such as
community based Paramedic Practitioners) to manage demand in the local
community while simultaneously reducing demand on A&E departments and
conveyance rates to hospital for the ambulance service.
Timescales and Milestones

Service specification and job description
for the Paramedic Practitioner role –
completed August 2013.

Agreement from GP Practices in
Northallerton (suggest working across
both Mowbray House and Mayford
Surgery) and Whitby (suggest Whitby
Group Practice) localities to host a PP
(based on existing models in Catterick
(Harewood practice) and
Sleights/Sandsend – March 2014.

Recruitment by YAS of 4 Paramedic
Practitioners – 2 from each local area –
Latest figures provided by the NHS suggest at least one million people are
currently taken to an emergency department every year, could be treated at
scene.
The primary role of the Paramedic Practitioner is the delivery of unscheduled care
to patients in the community by an appropriately trained health care professional
through integration with GP Practices in the Northallerton and Whitby localities.
The role of a paramedic practitioner (more advanced role to a paramedic) utilizes
Time to project
delivery (contract
award)
Time to steady
state (from
contract award)
6 months from
agreement and
formal confirmation
of the proposal with
YAS
Within 3 months
of
commencement.
the skills of paramedics and other professionals (such as specialist nurses with
additional skills) to support the first contact needs of patients in unscheduled care.
Paramedic Practitioners also independently provide definitive care that does not
require intervention of a GP/doctor. Paramedic Practitioners are normally
employed by the local ambulance service.
Based on a working pattern of 10 hours per day (0800 – 1800hrs) Monday –
Friday at two locations (Northallerton & Whitby) the scope of the Paramedic
Practitioner (PP) usually covers (but is not limited to) the following:

Administering medications within the remit of local PGD.

Prescribing medications to patients in line with local PGD.

Undertake routine assessments of patients with long term conditions in
their home. This helps people with such conditions to better manage their
own health and avoid unnecessary visits to hospital

Ordering x-rays and requesting further investigations

Take a holistic approach to patient care, bringing together their medical,
social and psychological needs

Encouraging the promotion of health education in the community

Treating minor illness and minor injury within an unscheduled care
environment or in the patient’s home.

Referring patients to alternative health and/or social services

Breaking down existing professional boundaries and encourage
collaboration.

Empowering patients to take responsibility for managing their own care
and treatment where it is safe and appropriate to do so

Undertaking an in-depth patient examination and assessment beyond
existing JRCALC (current practice framework for paramedics) guidelines

Identifying and providing alternative care pathways for the provision of
emergency care
June 2014.

New service planned go “live” October
2014 in Northallerton and Whitby.

Undertake audit and research be personally responsible for self directed
learning

Carrying out and interpreting diagnostic tests

Responding to Red 999 calls in the local area to their GP Practice base.
Patient
Acceptability &
Experience
The service should, based on existing scheme evidence from
the Harewood and Sleights/Sandsend practice models, lead
to a better patient experience as more patients are treated
closer to home and do not require conveyance to an A&E
department.
Complexity of
stakeholder
engagement /
providers working
together
The model would require the agreement of up to three GP
Practices to host a YAS Paramedic Practitioner within their
practice premises.
Resources
required to
implement project
The model can be delivered within existing management
resources from the CCG (Urgent Care Lead and GP Lead) and
YAS (locality manager with North Yorkshire Assistant Director for
A&E Operations support).
Certainty of
service continuity
Continuity of service provision is assured while extended skills
paramedic roles exist within the ambulance service.
The Paramedic Practitioner will also provide a faster and
more local response to 999 Red calls in the local area.
Patient Safety
Clinical
Effectiveness
Treating more patients closer to home more often and
reducing the need to attend A&E departments for treatment
improves the care available to those patients and other
patients who need the advanced clinical skills only available
through A&E.
Existing identical models of care already exist in the CCG
area at Catterick and Sleights/Sandsend.
Feedback from both primary care and YAS to the service
model since their introduction in August 2013 has been very
positive.
Equity of Access
The service model will would improve access to unscheduled
care in the Whitby area, where ambulance travel times to
their nearest A&E department in Middlesbrough are
considerable.
Based on current evidence the extended skills role is one that is
expanding rather than declining with operational and strategic
support from both the ambulance service and commissioners.
Confidence in
market
The Northallerton model should reduce A&E attendances at
the Friarage Hospital site thereby improving access and
reducing waiting times for patients requiring A&E care at the
Friarage.
Sustainability /
Corporate Social
Responsibility
The model should result in a reduction in conveyance rates to
A&E departments for both the ambulance and self
transporters thereby reducing the local carbon footprint as
YAS are fully supportive of further developing the model in
partnership with HRW CCG as a key strategic and operational aim
in delivering improved unplanned care service and response in a
highly rural area.
Competition between NHS ambulance services for contracts has
not included A&E services (employer of Paramedic Practitioners)
to date. There is currently no indication that this is likely to change
in the foreseeable future.
Private sector competition is currently restricted to non-emergency
PTS and some providers are now showing an interest in the
delivery of some Urgent Care transport.
Information
Availability
Early evidence (3 months) from GPs/YAS working with the
existing schemes in Catterick and Sleights/Sandsend is very
more unplanned care is delivered in local communities.
positive.
The only sustainability risks with the model are the
recruitment and retention by YAS of Paramedic Practitioners
local the Whitby and Northallerton areas.
Evidence from similar (ECP) schemes in other localities across
North Yorkshire reports excellent outcomes for patients in terms of
numbers treated locally and not referred onto A&E and also in 999
Red call responses in the local area.
Risks
Risks identified (including unintended
consequences)
Based on identical existing models there are no
foreseeable intended (or un-intended) risks with this
model.
Mitigating actions
Timescale
N/A
N/A
Method of Identifying (including KPIs)
Where are savings released?
Benefits/Outcomes
Benefits/Outcomes
Adding two additional PPs across HRW (Northallerton
and Whitby) would result in more patients with urgent,
(but not life-threatening), conditions from those towns
being treated at home rather than being taken to
hospital.
This would benefit, for example, older people who have
had a fall and suffered cuts, bruises or other minor
injuries and would prefer not to leave their home for
treatment.
Evidence of existing Paramedic Practitioner schemes
working to a Standard Operating Procedure shows more
patients are treated in their own community, reducing
999 ambulance call outs (hence leaving more
ambulance resource in the local community more often)
and subsequent ambulance conveyance rates to A&E,
which in turn reduces pressure on the 4hr A&E target
and associated ambulance turnaround times from A&E.
The Paramedic Practitioners would have the use of a
YAS rapid Response Vehicle (RRV) allowing them to
respond to 999 Red emergency calls in the local area.
Quantity & Volume of the Service
 Number of referrals received by the Paramedic Practitioners from
practice staff.
 Number of these referrals treated or referred onto alternative or
further care (other than hospital) by the PP.
 Number of 999 Red calls responded to in the local area.
 Number of 999 Red calls responded to within 8 minutes.
Quality of the Service




Compliments received
Complaints received
Practice assessment of service quality delivered to their
patients
Paramedic Practitioner’s assessment of the quality of referrals
made by practice staff
Whether the service has made a difference
Once fully established within the
community a cost reduction (through
A&E tariff savings) against the total
overall cost of the PP investment would
be the most likely scenario from the
schemes in Northallerton, Whitby,
Catterick and Sleights/Sandsend.
Evidence from other schemes reports a high response
percentage within 8 minutes.
Stakeholder group and purpose



Yorkshire Ambulance Service NHS Trust
GP Practices in Northallerton and Whitby
HRW CCG
£’000
Expenditure
FY14/15
6mths effect = £78.5k

Reduction in A&E attendances – based on patient numbers
seen and treated/referred (away from A&E) by the PPs
 Hospital admissions avoided (based on A&E attendance
conversion rates).
Method of engagement and frequency

Engagement with GP Practices involved and local YAS
operational leads to establish and introduce the new model
locally and planned “go live” dates.
FY15/16
FY16/17
Exit plan
6mths notice given to YAS to allow
integration of PP staff members back
into YAS core establishment as part of
normal staff turnover and recruitment in
HRW area.
FY17/18
FY18/19
12 mths effect = £157k
12 mths effect = £157k
12 mths effect = £157k
12 mths effect =
£157k
£30k
£30k
£30k
£30k
3.5 WTE PPs (based
on 100hrs per week
including relief) – top
AfC Band 6 (plus 30%
on costs) = £45000 x
3.5 WTE = £157k
Saving
6mths effect = £15k
1 patient attendance at
A&E per PP per day
are avoided = 10
patients per week
across the two new
schemes = 520 patient
attendances avoided
per year.
520 A&E attendances
@ £57 per attendance
= £30k FYE
Total
Total net
cost
(savings)
63.5
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