BPA Representation to Lord Warner
The BPA has written to Lord Warner on the subject of ECP's and Paramedic development. Our letter and the reply from Lord Warners Office are found below. The subject of ECP registration is not concluded and much work is still to be done.
The BPA would hope that more ECP's join our professional body in order to maintain the professional continuity much needed for unscheduled and emergency care to ensure the best for the profession and our patients.
Dear Lord Warner,
Emergency Care Practitioners - Professional Regulation
The British Paramedic Association is the professional body for the Ambulance profession, and has the predominant responsibility for the Paramedic element of the profession. I am writing to you in respect of the Emergency Care Practitioner (ECP), which is an important new role in the provision of health care in the modern NHS.
Currently a very high percentage of ECP's, certainly in the region of 90 percent if not greater, are recruited from a paramedic background. Furthermore incorporation of ECP skills into paramedic practise represents a natural and common sense progression and extension of the paramedic current role in meeting demands from emergency calls for medical help. This position was recently codified when the Quality Assurance Agencies Paramedic Benchmark Statement was successfully passed through a consultation process involving the DH. The document included ECP skills within the paramedic curriculum.
The value in providing paramedics with the ECP
skills is clear, especially so, given that many 999 calls generate patients
with minor illness and injury or social needs rather than true medical
emergencies, precisely the area of expertise of the ECP. In meeting demands from emergency calls for
medical help, it is very clear that this work will enable a more appropriate
response to many patients giving them wider choice in the delivery of their
unscheduled care. In turn it will allow
the ambulance profession to provide a more responsive service to those patients
with acute or life threatening needs.
It is the question of regulation and
registration that I wish to draw to your attention, ensuring that the final
decision about regulation of the ECP will make certain of a high level of
public protection and attract staff from the health professions in to the work
of the ECP. The current approach to the
question of regulation would seem to be advocating a position whereby ECP's should
be placed on a separate register and regulated as a profession in its own
right. Should this occur then the
British Paramedic Association would see this as a retrograde, damaging and
wholly unnecessary step that would not militate in favour of encouraging a
modern and safe approach to the regulation of health care professionals.
The regulation of ECP's as a separate
profession is unnecessary and uncalled for. The development of appropriate
education and additional competencies would be better undertaken from the base
of a primary registration, whether from Nursing or the Allied Health
Professionals. The extended
qualifications gained through the educational development for an ECP could be
annotated to the primary registration as a recordable qualification similar to
that found in the Nursing profession or as an entry to a specialist register as
found in the Medical Profession.
Given the high percentage of Paramedics
currently undertaking the role of ECP in health care delivery, it is difficult
to envisage that they would wish to give up their primary registration as a
Paramedic in favour of a separate registration as an ECP. This would lead to dual registration, which I
understand is not favoured by the Department of Health. It would also require
those Paramedics wishing to undertake the role of an ECP to pay additional
registration fees for their new and separate profession and maintain two CPD
portfolio's. This arrangement might also cause difficulties in dealing with
disciplinary and other regulatory issues Most of the current ECP models enable
paramedics to respond to acute and life threatening calls within their scope of
practice as an ECP, therefore allowing a more efficient and effective use of
NHS resources.
From the outset the ECP scheme has promoted the concept of Paramedics and Nurses working more flexibly and across boundaries as inter-professionals. This plasticity has been possible without any need for a separate register and indeed there were many examples of both Paramedics and Nursing staff working in this way before the national ECP pilot programme was developed. This flexibility would enable a Technician or a Paramedic to refer a patient to an ECP where the level of Paramedic skill was not necessarily required at this moment. Such arrangements would provide for seamless care for the patient and harmonious working across the profession, yet allow for maximum safety for the patient within the boundaries of excellent clinical governance.
The concept of the Paramedic specialist practitioner as found in Agenda for Change (Band 6) could be easily achieved through recordable qualifications or an elevated register from the primary registration. This would have to go through the evaluation process but would be based on expanded scope of practice (designed to address category "C" calls - unscheduled care) and thereby reducing significantly the administrative effort required to undertake the same work for a separate profession. This arrangement could easily work for a member of the Nursing or Allied Health Professions wishing to expand into ECP roles.
One particularly important area that has been raised is the matter of non medical prescribing rights. These are not currently available to Paramedics, but with the review of prescribing, supply and administration of medicines (1999) which recommended two types of prescriber. Independent prescribing rights were introduced in 1996 for District Nurses and Health visitors with Nurses being able to prescribe from an extended formulary since 2001 following completion of V200 and V300 nurse prescribing courses.
Supplementary prescribing was made available to Podiatrists, Physiotherapists, Radiographers and Pharmacists in April 2005 with optometrists coming 'on board' in the late summer of 2006. An argument has been put forward that dependent or supplementary prescribing rights should be made available to ECP's through a separately regulated profession. The work necessary to achieve this would be better directed toward enabling supplementary prescribing rights for Paramedics in line with other AHP's which could be expanded to independent prescriber status on achieving extended scope of practice, thus improving the flexibility that the modern NHS seeks to provide and reducing the burden on the legislature.
The current ambulance service role is well known to respond for an extremely wide patient group who all see their needs as fitting an emergency request for help. The ambulance profession has operated in this way for some 5-6 decades. It is only now that we are in the position where alternative and more appropriate responses are being considered. Through extending the scope of practice and its associated education for Paramedics, Nurses or other allied health professionals in becoming ECP's, the vision for improved care can be easily realized. To continue to protect the public through robust regulation and registration the retention of a primary registration with recordable qualifications or the use of a specialist register within the primary register will serve the public and the profession in the best possible way.
The Paramedic profession requests that you would consider the views in this letter very carefully as we see the regulation of health care professionals extremely important in protecting the public and removing the risk of confusion or abuse brought on by multiple registration.
Yours sincerely
Roland Furber
Chief Executive
British Paramedic Association
College of Paramedics
Roland Furber
Chief Executive
British Paramedic Association
College of Paramedics
28 Wilfred Street
Derby
DE23 8GF
Thank you for your letter of 3 January about the professional regulation
of Emergency Care Practitioners. I apologise for the delay in responding.
I understand that you are particularly concerned that paramedics who become Emergency Care Practitioners may be obliged to give up paramedic registration and register separately as an Emergency Care Practitioner (or else hold dual registration).
A number of proposals are currently being considered as part of Andrew Foster's review, and it would be premature for me to make any announcement on these issues at this stage.
I can assure you that when we bring forward the necessary legislation on these proposals, there will be full consultation on all aspects of them.
I share your views about the value of the service that paramedics already deliver and the ways in which this could be augmented even further by the use of Emergency Care Practitioners. I keep an open mind about how many of the new Emergency Care Practitioners need to be drawn from the ranks of existing paramedics, and any system of regulation for Emergency Care Practitioners needs to keep all the options open.
hope that this reply is helpful.
Yours ever
Jane Kennedy
Tue, 14th March 2006