Paramedic In The Community

Where did we start?

Keep Shifting Left…

Paramedic Training to Education

<2005 – IHCD/EDEXCEL 2006 – Level 5 DipHE, FdSc (&BTEC4) 2015 – Level 6 BSc (Hons) SECAmb 2019> - All Level 6

History of the practitioner role 1998 Audit Commission Report Need for fully crewed ambulance to every 999 call questioned. 1999 Practitioner in Emergency Care Ambulance Services Association & JRCALC 2000 Emergency Care Practitioner NHS Modernisation Agency 2002 ECP pilot scheme – Coventry & Warwickshire 2002 Paramedic Practitioners – SYAS Decrease in A&E attendances and admissions within 28 days [Mason S, Knowles E, Colwell B, Dixon S, Wardrope J, Gorringe R, et al. Effectiveness of

paramedic practitioners in attending 999 calls from elderly people in the community: cluster randomised controlled trial. BMJ 2007]

2005 ‘Bradley Report’ 90 % of 999 patients require “urgent primary care.” “wider role as mobile healthcare providers” “support primary healthcare teams & community matrons.” 2006 Paramedic/Nurse Practitioners – SECAmb 18 month BSc/Dip Health Practice, St Georges 

History of the practitioner role continued 2008 Lord Darzi report - High Quality Care for All. Right care, right time, right place.

Leading to: 2009 NHS constitution – Putting the patient at the heart of everything we do.

Includes improving access to healthcare 2013 Keogh report – Urgent and Emergency care review. 1 million A&E

attendances avoidable. 50% of patients could be managed at scene. Too many choices confusing for patients.

Paramedic Practitioner Is an autonomous Allied Health Professional Recruited from Paramedics with at least 2 years

experience who pass a multiple mini assessment process

Purpose of role is to provide assessment and management for patients with a range of urgent and emergency care needs.

Provide clinical leadership and supervision Promote patient safety Still very much a paramedic – still attends cardiac

arrests and RTCs!

Paramedic Practitioner Education BSc (Hons) ‘top-up’ or PGDip module pathways at St

Georges University of London or University of Surrey Placements carried out with GP’s, MIU’s and specialists Assessed by OSCE, work books and reflective writing 2 years part time whilst still working 8 week GP Placement Specialist Paramedic Exam and OSCEs as final exam

HEI Modules Physical Assessment Clinical Decision Making, Judgements, Managing Risk Drugs and Therapeutics Management of Minor injuries Management of Minor illness Mental Health Priorities for Healthcare Professionals Physical Assessment of Children Managing Long Term Conditions

Challenges Activity Variance Handover Delays Balance of SRVs and DCAs Skill Mix Job Cycle Time

1 May 2023 10

Why do we need to change? Five year forward view (alternative delivery models/integration) Taking healthcare to the patient [2] (Darzi) Hospitals under pressure Patient satisfaction GP shortages Staff morale Frequent callers Local Socio-economic requirements Local pathways Rising Demand

What is a Community Paramedic?

The Community Paramedic Model

Thanet Operating Model Taking 5 of 8 points from the plan for 14-16

hours a day – critical mass required Front loading ‘most skilled’ clinician (RAT) Shifting transports (number and type) Aims to:

Improve performance Reduce conveyance and double resourcing Shift skill mix Focus resource

1 May 2023 14

6 Community Paramedic Teams• Canterbury East (with GP home visits)• Canterbury West (with GP home visits)• Deal (with GP home visits)• Faversham (with GP home visits)• Herne Bay• Whitstable (with GP home visits)

3 Points on the SSP• Thanet North• Thanet South• Westgate

Operating Model and Home Visiting Operating model designed to stand alone Home visiting provides additional

opportunity Currently several models in place Shift toward two broad inter-connected

models

1 May 2023 16

Electronic Patient Record e-pcr EMIS Vision IBIS Share my care

Monitoring Closely

LATEST MONTH 2013 (Feb - HPM) 2014 (Feb - HPM) 2015 (Feb - HPM) 2016 (Feb - CBM)

1.28 2.3% 1.31 3.7% 1.36 -9.7% 1.24

26.8% 5.1% 28.3% 11.1% 31.8% 16.1% 37.9%

60.0% -6.2% 56.5% -6.0% 53.3% -10.3% 48.3%

FEB

Average Vehicles on Scene

See and Treat

Convey and Treat

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

32.73%

37.88%

32.53%33.81%

% See and Treat(Treat at Scene)

Thanet Polynomial (Thanet)SECAmb Polynomial (SECAmb)

One of the primary objectives of the CBM is to change the existing de-fault of "take to hospital" to a new default of "treat out of hospital".

One hypothesis taken from this is that the number of people treated at scene should increase. This has been evidenced by the data taken from the INFO.SECAMB CAD.

At the beginning of 2015, both the SECAmb wide percentage of pa-tients treated at scene was almost identical to the Thanet average. This trend continued throughout most of 2015.

However, during the CBM pilot in 2016 there is a clear increase in the percentage of patients treated at scene in Thanet at 37.8% and that this is at a noticeably higher level than that of the SECAmb wide average of 33.8%.

Patient Satisfaction100% replied – would be happy to see a

paramedic practitioner againStaff Survey

Now doing a job they we are trained to doGP Survey

Patients are receiving a more timely home visit

What’s Next? Monitor Closely Clinical Governance Meetings Refine Near patient testing Building Multi Disciplinary Teams

25

Thanet Initial Indicators• Response Time Reliability is improving on the Trust DD league table and

holding up during demand escalation until DMP2.• R1 conveyances are increasing, R2, G2 and G4 conveyances are decreasing• Higher staff satisfaction with the new way of working

Key Lessons Learned• Not enough Commissioner engagement• Clinical stratification of performance improvement• Specification of new Management Information required to operationally

manage the model

Benefits Access to records Closer working with local system Access to pathways Knowledge of patients/frequent callers Conveyance Rates… up and down

Questions