Comment

Time to address paramedic retention rates

Following the National Audit Office’s (NAO’s) recent report into NHS ambulance services, Gerry Egan, chief executive of the College of Paramedics, says careful attention is needed to assess the reasons why so many paramedics have left, and continue to leave, the ambulance services.

The College of Paramedics welcomes the NAO’s recent report into NHS ambulance services, which has identified some of the fundamental issues that are causing pressures on ambulance services and their performance.  

We agree with the recommendations made in the report, but we also believe further work is needed to ensure that education, paramedic career grades and paramedic skills are aligned to the guidance offered by the college. Standardisation across these facets will enhance the likelihood of new developments, including independent prescribing by paramedics, and open the way for the full appreciation of the roles and roll-out of specialist, advanced and consultant paramedics, and facilitate the new models of care to address a growing problem of national scale and importance. 

There is wide variation across the 10 ambulance services in England in their approaches to utilising the workforce and adopting national guidance from the professional body on career grades, including specialist, advanced and consultant paramedics, and the benefits these can offer to the new models of care. 

Members of the college have long reported the growing problems of unabated increasing demand made worse by delays in handing patients over at emergency departments. This is a significant factor in the current problems, for which some relief would be realised through new models of care out of hospital. Over the last decade, the college has promoted the contribution to the management of emergency and urgent care that could be made by a fully developed paramedic profession. It agrees with the finding in the NAO report that commissioners need to see ambulance services as an integral part of any strategy to manage emergency and urgent demand, but would go further to suggest that commissioners should also seek to fully understand the capabilities of paramedics, specialist, advanced and consultant paramedics. Paramedics have a part to play at various stages of the patient journey, whether it is through telephone or face-to-face assessment and subsequent treatments or referral decisions, and the college firmly believes that all 999 patients should receive paramedic-led care. 

Since registration in 2000, and the parallel developments led by the professional body, it is estimated that no more than 80% of paramedic registrants now work for NHS ambulance services. Some migration may be due to the hazardous ambulance environment, as highlighted in the report, which in turn may be contributing to higher levels of sickness than in other health services. 

Members have reported a range of factors that have influenced their decisions to leave ambulance services, including the stressful nature of constant demand, lengthy and extended shifts, lack of meal breaks, lack of parity with other professions in pay and general recognition, lack of development opportunities and, in some cases, bullying and harassment. Whatever the reasons, it remains a fact that paramedics who were once the sole domain of ambulance services have not only chosen to leave but have also found themselves in demand from other healthcare providers. It appears that other services have been quick to appreciate the role and contribution of paramedics in delivering safe and effective care in a range of settings outside of the ambulance services. 

Given that backdrop, the college believes retention will be a longer-term and possibly more difficult problem than recruitment, especially as there is overwhelming demand for places on paramedic degree courses at universities throughout the country. 

Careful attention is needed to the reasons why so many paramedics have left, and continue to leave, the ambulance services. For a workforce that is central and integral to the performance and service provided by the ambulance services, it would be a positive message for there to be a requirement that there should be an experienced paramedic on each ambulance trust board. 

This is a profession that has been established for almost 17 years, and has developed education curricula and career frameworks for all stages of paramedic progression, but its members may perceive the absence of paramedic leadership at board level as an indication of their worth in the ambulance sector.

For more information

W: www.collegeofparamedics.co.uk

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