1. PECs: from concept to reality Nikki Williams Malcolm Woollard

2. Drivers for change... Meeting challenging performance standards Rising number of 999 calls Workload of A&E departments Challenges facing primary care Clinical governance

3. The need for higher education... Current paramedic training focuses on life-threatening conditions –provides limited under-pinning knowledge –is protocol driven All other professions within the HPC mandate graduate entry

4. JRCALC/ASA - PEC concept... Generic Emergency Practitioner –advanced knowledge / skills critical care triage treatment of minor conditions –3-year Full-time Degree plus probationary year –rotation between different health care settings

5. Meanwhile... A few HEIs offering B.Sc. degrees for paramedics –developed in collaboration with partner ambulance services to meet local needs –full & part-time, pre and post registration –not aimed at advanced clinical practice –no strategic management of developments

6. Towards consensus... Higher Education Ambulance Development Group (HEADG) –representatives of universities and ambulance services involved in higher education for ambulance staff –representation sought from JRCALC, BPA, HPC, ASA, AETAG –specialist advisors

7. HEADG Aims to: –raise standards of education in pre hospital care –provide a framework of higher education for ambulance staff –devise subject benchmarks for degrees –reach consensus on the role, knowledge base and scope of clinical practice for PECs –develop national standards for PECs –undertake collaborative research / evaluation of education programmes

8. Title update... Practitioner in Emergency Care Emergency Care Practitioner Physician Assistant Intermediate Care Practitioner Community Paramedic Paramedic Practitioner

9. Proposed Education Framework

10. Some questions... How can we improve management of non-emergency 999 patients? How can the problems with primary care be addressed? Can available resources be better employed to improve patient care? One possible solution...

11. Welsh Paramedic Practitioner scheme... Partnership between Swansea University, the Welsh Ambulance Service, local NHS Trusts and primary care providers. 2-year pilot study –year one: 2 days per week at university and 3 days per week in clinical placements –year two: spent practising under close supervision of academic and clinical staff, with 1 day per month at university

12. Cross-boundary working... Innovative role Taking on some doctors’ work Autonomous, advanced clinical practice Guidelines not protocols

13. A question of level... Paramedic practitioners will need to: “... deal with complex issues both systematically and creatively, make sound judgements…” “...act autonomously in planning and implementing tasks…” “…practise decision-making in complex and unpredictable situations…” QAA descriptors for M.Sc. level

14. Educational programme M.Sc. Advanced Clinical Practice –multi-professional programme –fosters inter-professional communication and understanding –shared core modules –specific modules for paramedic practitioners –focus on developing advanced levels of clinical practice

15. Practice component... Clinical Placement Duration A & E13 weeks Primary Care 15 weeks Obstetrics & Neonatal Unit 1 week Paediatrics 4 weeks Mental Health 1 week Cardiology 2 weeks Anaesthetics 8 weeks

16. Looking to the Future... Practitioner-lecturers Clinical mentors Recruitment & retention

17. In summary... Evolution of original concept Consensual approach to new developments Develop a practitioner fit for practice