Advanced Paramedic Practitioners Programme

In 2018 Betsi Cadwaladr University Health Board (BCUHB) and Welsh Ambulance Services NHS Trust (WAST) were jointly awarded Welsh Government Pacesetter funding to design and deliver an innovative three-part rotational model of working. The model saw Advanced Paramedic Practitioners (APPs) rotate between the clinical control centre, solo responding for WAST, and in primary care sites for BCUHB.

Broadly, the aim of the project, was to examine whether each element of the three-part rotation enhanced clinical practice in the other two parts. A further objective was to assess the creation of additional capacity within primary cares ettings, and test the assumption that a viable role exists for WAST APPs in the delivery of primary care services. In addition, as a transformational project, the team needed to demonstrate through their learning, what the most effective model of rotation would be, that benefitted patients, WAST and primary care.

An extensive evaluation framework was designed using the Logic Model at the outset of the project; this was reviewed and amended as the project progressed. It was flexible enough to accommodate emerging themes and robust enough to enable the removal of areas of initial interest.

The project concluded in spring 2022, and a comprehensive service evaluation undertaken alongside the Pacesetter has been able to demonstrate that it is a valid model of deployment for this group of staff and that there were identifiable benefits for patients, WAST, primary care, and the APPs.

This model has now moved to business as usual across north Wales. The first two cohorts are still working in primary care, they have been joined by a third cohort and a forth cohort who are now in training.

Foreword

The role of the paramedic has been constantly evolving since inception to meet changing demands, including access to higher education pathways leading to clinical career progression. Extended roles, such as advanced clinical practice have opened up new career options for experienced and educated paramedics to work in patient-facing senior clinical roles outside of the traditional paramedic employer, the ambulance service.

The challenge now for any modern ambulance service is how to provide a long career with varied options for the groups of staff that have had significant investment in their professional development; particularly when this development makes them an attractive employee for other health care organisations. Data from England indicates that an increasing number of paramedics are making the choice to work in Primary Care. There are certainly advantages to the individual paramedic and practices, however the transition to a new work environment may not always be the right move for some, and while a number of paramedics return, the intellectual contribution for those that stay away means ambulance services lose out on the benefits that working in other health sectors can offer.

From a system perspective, this is an inefficient way of delivering healthcare, and organisations that compete for talent against each other may not be able to work closely together to deliver excellent joined up care. The purpose of this Welsh Government funded Pacesetter project was to test an extended rotational working pattern following a successful internal pilot project. This extension was for a small group of advanced paramedic practitioners to include working within Primary Care. The benefits were assumed to be two-fold, to support workforce sustainability in Primary Care and to bring the benefits of extended clinical and Primary Care system knowledge back into the clinical contacts while working with Welsh Ambulance Services.

The reports that could be found here are the results of a three year project with seven areas of interest evaluated which includes the rotational model, impact on Patients, Primary Care, the Paramedics and the Profession, and the Skills, Education, Training and Supervision (SETS) requirement.

The Project Team have also reflected on their learning throughout the project and all members have been able to identify personal and professional development as a direct result of being involved in this Project.

Gemma Nosworthy

Primary & Community Care Academy Manager