Published on July 13, 2016
1. Paramedic In The Community
2. Where did we start?
3. Keep Shifting Left…
4. Paramedic Training to Education <2005 – IHCD/EDEXCEL 2006 – Level 5 DipHE, FdSc (&BTEC4) 2015 – Level 6 BSc (Hons) SECAmb 2019> - All Level 6
5. 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
6. 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.
7. 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!
8. 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
9. 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
10. Challenges Activity Variance Handover Delays Balance of SRVs and DCAs Skill Mix Job Cycle Time 13 July 2016 10
11. Why do we need to change? Five year forward view (alternative delivery models/integration) Taking healthcare to the patient  (Darzi) Hospitals under pressure Patient satisfaction GP shortages Staff morale Frequent callers Local Socio-economic requirements Local pathways Rising Demand
12. What is a Community Paramedic?
13. The Community Paramedic Model
14. 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 13 July 2016 14
15. 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
16. 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 13 July 2016 16
17. Electronic Patient Record e-pcr EMIS Vision IBIS Share my care
18. Monitoring Closely
19. 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 AverageVehiclesonScene SeeandTreat Conveyand Treat
20. 32.73% 37.88% 32.… 33.81% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% 45.00% % See and Treat (Treat at Scene) Thanet SECAmb Poly. (Thanet) Poly. (SECAmb) One of the primary objectives of the CBM is to change the existing default 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 patients 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%.
21. Patient Satisfaction 100% replied – would be happy to see a paramedic practitioner again Staff Survey Now doing a job they we are trained to do GP Survey Patients are receiving a more timely home visit
22. What’s Next? Monitor Closely Clinical Governance Meetings Refine Near patient testing Building Multi Disciplinary Teams
23. 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
24. Benefits Access to records Closer working with local system Access to pathways Knowledge of patients/frequent callers Conveyance Rates… up and down
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