About the programme
It is widely acknowledged that there is a shortage of suitably skilled clinicians to support primary care delivery, especially within the context of an increasingly multidisciplinary primary care workforce. NHSE’s `Update to the GP Contract Agreement (DES) recommends use of allied health professionals (AHPs) to support GPs across England, it includes financial support for use of ‘Community Paramedics’ from 2021.
Over recent years around 700 (NHS Digital, 2019) experienced paramedics have left traditional emergency roles, applying their generalist skill-set to employment in the primary care sector (in and out of hours). However, this has been on an ad-hoc basis with little standardisation of approach and there remains a shortage of paramedics who are adequately trained to enter the sector.
What is the Paramedics in Primary Care (PiPC) Project ?
The Paramedics in Primary Care (Phase 1) project was designed and implemented in the South West in 2018/19 in order to test whether a supply of suitably qualified paramedics could be provided to the primary care sector in response to the GP DES.
The DES contract Additional Reimbursable Roles Scheme funding is linked to expectations around scope of practice, skills and qualifications in primary care, (see link above) all of which paramedics can learn under the PiPC programme.
The original ‘proof of concept’ project aims were to design and deliver a student-focussed, cost effective, high quality education programme with both accredited academic plus experiential learning elements, alongside an aim to be minimally disruptive to the ambulance service workforce.
Following widespread stakeholder engagement (including with South Western Ambulance Service), the project scope was offered to experienced paramedics already working either in the emergency care and/or primary or urgent care sectors who are working towards the range of knowledge and skills outlined in HEE’s Advanced Clinical Practitioner (ACP) and Paramedic Specialist in Primary and Urgent Care Capabilities Frameworks.
PiPC students are high-performing paramedic graduates, who elect to reduce their contracted working hours with the ambulance service, (or other employer) to enable part-time study and placements on the PiPC pathway.
Typically, once on the PiPC programme, students elect to complete 2 or 3 days per week within their frontline ambulance role (usually a 0.6 – 0.8 whole time equivalent part-time contract) whilst attending one day of clinical general practice placement (facilitated by the local HEE Training Hub) and one notional study day as part of the bespoke MSc PiPC programme. The MSc is delivered as 100% distance learning in order to facilitate practice-based learning.
Trainees undertaking the PiPC development pathway will complete the full masters in 3-years as experienced paramedics working either in emergency care or in the primary and/or urgent care sectors.
An important key feature of PiPC is that practice placement time is supported financially by HEE, using the HEE non-medical placement tariff.
Another key point is that the programme offers participating GP’s the opportunity to employ their PiPC trainee at any point during the development pathway, making full benefit of the GP DES reimbursable role opportunity from 2021.
The working aim of PiPC is that it will create a safe, capable and confident clinican who can operate effectively in a portfolio-working fashion across the primary and emergency sectors.
Trainees will complete Non-Medical Prescribing as a final year module. Alongside the range of university Masters assessment processes, trainees also commit to undertaking the College of Paramedics/St Georges, London Diploma in Primary and Urgent Care (Dip.PUC) exam during the second year. They evidence their practice-based learning by using the Clarity Informatics Appraisal Tool for Paramedics (e-portfolio and appraisal), which has been designed for PiPC and utilises existing national guidance on core capabilities for paramedics working in primary care.
Training Hubs provide two supporting roles to PiPC trainees, these being the Education Coordinator who covers overall local PIPC management, pastoral, placement and university liaison, and the Clinical Fellow who covers clinical development, CPD provision, progress and liaison with the GP clinical supervisor and ‘in-practice’ supervisory team.