NHS England is developing proposals to train paramedics to become Paramedic Independent Prescribers (PIPs), and provide certain services performed by GPs. I understand the driver: there is a shortage of GPs. I understand the solution: paramedics are medically trained and can, I’m sure, deliver certain GP services. However, we need to be careful not to add unmanageable burden to ambulance trusts, many of whom are already struggling.
In December last year, The Guardian reported that three ambulance trusts rated their status as ‘critical’, just short of the ‘potential service failure’ rating, with more classified as under ‘severe pressure’. But don’t believe that this is simply some sort of Christmas-period issue. In July last year, The Spectator has reported “Figures from the London Health Board showed that 238 people left the London Ambulance Service (LAS) in 2013–14. Only 80 left in 2011–2012.”
My first response to the proposals was “What?! Aren’t they busy enough??” But, the proposals do, of course, have pros and cons. On the one hand, they may offer paramedics valuable career objectives to train and develop further. This may stem the exodus observed by The Spectator. They may also offer the NHS a cost-effective means of satisfying a never-ending demand—hugely desirable by government, doctors and patients. The consultation document says paramedics could be used in “Accident and Emergency Departments, GP practices, Minor Injury Units, Walk-in Centres and Out-of-Hours services“—five very busy health settings that need support.
On the other hand, they may take an already busy workforce and make it work harder, perhaps for unsustainably long hours. And the additional burden doesn’t end with the paramedic. The consultation document says: “Employers will retain responsibility for ensuring adequate skills, safety and appropriate environments for paramedic independent prescribing.” So, training and development costs will be for ambulance trusts to manage—not the beneficiary organisation (such as an acute trust or Clinical Commissioning Group).
The proposals deserve close study and careful answering. Supporting the NHS is important; supporting the ambulance service is equally important. If these proposals are introduced, it’s important that they don’t simply benefit one system at the expense of another.