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The role of the paramedic within the NHS unscheduled care agenda relates to direct urgent or emergency patient care. In context to paramedics, it is directly about urgent care and emergency care, both types of care requiring assessments and planned interventions. (Making connections with the challenges of unscheduled care, 2012). Paramedics have the duty when called out to assess all aspects of the patient, from their called complaint to their social history. Paramedics must take everything into consideration in order to effectively implant a planned intervention to prevent an emergency which will require immediate care or assistance in the near future. After assessing patients, paramedics have to make the critical decision to admit patients to a hospital, to refer them to other health services or to leave them at home, but they must have valid and strong evidence to support that decision. (Paramedic – Scope of Practice Policy, 2017). The main role is to go through efficient triage and thorough examinations in order to provide a pre-hospital temporary treatment which can also be a planned intervention. The Scope of Practice Policy published by the College of Paramedics describes the paramedic role as a role where paramedics ‘holistically assess, and if required treat and manage service users presenting with physical or mental health complaints; either as the result of injury, illness, or an exacerbation of a chronic illness.’ (Paramedic – Scope of Practice Policy, 2017). They are the first clinical or healthcare professionals that a member of the public will come into contact with, therefore policies and procedures have been set in place by paramedic regulatory bodies such as the Health and Care Professions Council (HCPC), College of Paramedics which are also known as the British Paramedic Association and the National Institute for Health and Care Excellence (NICE). These bodies provide guidance and support to ambulance services, so every student and qualified paramedic is able to safely provide care to patients, be able to use the correct techniques and necessary equipment effectively to holistically support members of the public.
The unscheduled care agenda does have some issues within it that effects the duty of the paramedic and how patients receive treatment, according to the NHS Grampian website, they state that ‘over recent years, services that provide unscheduled care have been under increasing pressure’ (Nhsgrampian.org, 2019). Paramedics are apart of the many services that face pressures when it comes to giving patient care, as well as being able to admit patients into hospitals as the hospitals and the departments within them, face their own pressures. In a wider multi-disciplinary team, paramedics are able to lessen the pressures on further services; they are able to work on a patient, be able to administer care and treatment on scene and either make a referral to other services that prevent the patient from going into hospital for a minor issue, or they assess and treat patients and leave them at home with advice. In most cases, a hospital is not where a patient needs to be unless they have symptoms that concern paramedics. With care essentials and equipment being limited on an ambulance, paramedics face the pressures of making the decision on whether a patient should go to hospital or not but in the best interest of many patients, they try to keep the care close to home and prevent people going into hospital and having to wait many hours to receive care. Paramedics work with multiple professionals in a multi-disciplinary team in order to achieve this goal, they work within the community which means that they also work with professionals outside of health care such as fire services, police services, and social services but when it comes to care, paramedics work with medical and mental health professionals for further clinical advice or referrals, such as specialist or advanced paramedics when it comes to receiving immediate advice. When it comes to patients who have multiple and complex conditions, paramedics can work with other services in a multi-disciplinary team to give patients the right care the first-time round in a safely managed environment like their homes or in community care settings. This then results in fewer people being admitted into the Emergency Department and having to wait long periods of time as well as the number of subsequent general admissions to the hospital being lower. (Health Education England, 2019). Paramedics like every other health care professional will do things such as safeguard confidential information which is protected and practiced under the Data Protection Act 1998 and when it comes to either receiving information or handing over information to other professionals, they must ensure that consent from the patient is provided as well as that any information given should be for reasonable causes, such as giving the name, address and case code to a receptionist at Accident and Emergency when booking the patient into hospital. If patients have concerns or if they wish information to be disclosed confidentially, paramedics when doing a clinical handover should attempt to disclose information in a private setting. When working with other professionals in a wider multi-disciplinary team, it would be beneficial for paramedics to use clear communication as well as be able to work well with other members in their service as well as others as then, barriers can easily be overcome through the support of others.
There are many contemporary issues that could impact Paramedic practice, some being more minor to others such as the lack of training and the lack of people following policies and procedures to the mental health of paramedics and academic standards in order to qualify and work. Education in paramedic practice has become a heated contemporary issue as it affects current paramedics and future qualified paramedics, it is something that is currently happening and being reviewed by the HCPC which is the regulatory body that consulted on changing the registration requirements to degree level in March 2018 (Timms, 2018). This contemporary issue was commissioned by the Department of Health and Social Care once the Allied Health Solutions in 2013, published a report called the Paramedic Evidence-based Education Project; also known as PEEP. It was then when it was decided that the paramedic profession should be studied at BSc Degree for then in 2017 the HCPC consulting on changing the registry requirements but only approving it in March. (Timms, 2018). The change was justified by regulatory bodies wanting to ensure that future paramedics were trained to the standards for contemporary practice and that students would be able to develop critical thinking as well as develop and gain evidence-based practice skills during their 3 years of study (Health and Care Professions Council, pp8-18, 2018). Doing a BSc Degree course in Paramedic Science/Practice is going to be needed in order to get onto the HCPC register and will be in full action in 2024, current paramedics who are already on the HCPC register are not directly affected but many are unable to go down the route of joining an ambulance service and partaking in short training programs before they go out and work on the road. There is a current threshold level of qualification for entry to the HCPC register and that is something that is ‘equivalent to Certificate of Higher Education’ (HCPC 2017) but paramedics who hold this qualification are unable to progress further into the paramedic role and become specialist or advanced paramedics or even work their way up into another job in the ambulance service or related NHS careers without holding a BSc Degree. This then means that people who already work within ambulance trusts such as technicians or clinical care assistants will have to apply to university and do a BSc Degree in order to progress and become a paramedic. For people who want to be paramedics, such as students, they are able to go straight into university and do their 3-year degree and be eligible to register, but current workers they may have to find time to do the course as well as have to pay the tuition fees of the course which costs around £9250.00 (University of Sunderland, 2019) and they are found on course fees of the university of choice.
The impact on the role itself due to the educational standards rising for registration effects the paramedic role both positively and negatively. In the positive aspect, the general role of the paramedic becomes more clinically advanced; all qualified workers will be at the same level of clinical and critical understanding and will all be able to work together and make clinical decisions in the best interest of patients which then is due to everybody having a BSc Degree and working on the same band. With patient standards rising and the paramedic profession becoming a profession where qualified members are now autonomous practitioners, paramedics will be able to work with patients in more of a clinical setting while ensuring the holistic needs of the patient are met. There are other out of curriculum and work opportunities that trainees and qualified workers can take part in, advanced paramedics are able to prescribe medications, only if they take on a prescribing course to become independent prescribers but it is only limited to prescribe medicines that are not controlled drugs until relevant legislation is updated. (Collegeofparamedics.co.uk, 2019). Now and in the near future the amount of people living with illnesses such as chronic illnesses will increase, meaning that the healthcare requirements to care for these people will increase. With the number of these patients increasing, paramedics deal with a broader range of complex and high quality care patients, but paramedics must be balanced with the skill and education level in order to deliver effective treatment for complex cases (Long Term Conditions Compendium of Information, 2012) therefore the new standard of them having a BSc degree was raised and is being put into place and once student paramedics graduate and register with regulatory bodies, they should be able to provide a broader range and better treatment methods within service users home or other services using their clinical decisions and skills, resulting in less hospital admissions. Educational standards can also affect the role of paramedics in the National Health Service (NHS) as well as unscheduled care, in 2016 a study was completed and it was discovered that there was a retention of paramedics within ambulance services who were affected by career and development opportunities that led to staff shortages (Harris, 2019). Due to that lack of development opportunities, paramedics and other workers in ambulance services were not able to develop their own skills and understanding of health and social care and that led to the number of qualified and experienced staff reducing. The lack of paramedics then effects the NHS and the unscheduled care agenda as may have led to current paramedics at the time, taking to people to hospital without making the correct clinical decision but with education now being available as well as it being a requirement, this is avoidable as all people in the workforce will be able to make accurate clinical decisions with valid evidence supporting their decisions and do it in the best interest of the patient. Paramedics may have not been able to follow the unscheduled care agenda due to their lack of education, but current paramedics are being made aware and have access to courses which teach them and make them aware of new policies and procedures that they follow such as the College of Paramedics, holding conferences for their members to participate in. (Collegeofparamedics.co.uk, 2019). Unfortunately, there is no standardised approach to all aspects of education to paramedics (Hee.nhs.uk, 2019) meaning that the issue will not be completely resolved, but with making the entry requirements and the registration standards higher, in order for the outcome to be more balanced, paramedics will be able to provide care and meet the needs of the unscheduled care agenda.
Paramedics have an important role in the unscheduled care agenda, as they are the primary source for emergency and urgent care, they have to make the important decision which then later can affect the whole agenda as it follows patients. There are contemporary issues like what was discussed which affects current paramedics and the future generations of paramedics, it affects how they work and also effects service users but once the implemented strategies, to change the problems, have been put into place, the role of the paramedic and how they practice may change and benefit the unscheduled care agenda in relation to urgent and emergency care.
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