Two perspectives on regulation of paramedics in the United Kingdom

Do you think regulation of paramedics in the UK was a good thing for paramedics?

As a whole I think that the formal registration and protection of title for paramedics in the UK has been beneficial for both us and the public.

For health care professionals it has raised awareness of our scope of practice, education levels and general clinical ability within other groups of health care professionals like nurses.

No I do not think regulation of paramedics was a good thing.

In UK there are many more deliverers of ambulance of services via Trusts which are fully funded and commercially competitive - therefore some type of regulation probably was needed

While registration was not mandatory for those working for an employer - the employer required registration so staff did have to get registered

It may have had some advantages for employers as paramedics could the carry controlled drugs like morphine and in future will be able to prescribe1.

Note in New Zealand the HPCAA does not give full protection of title.
Were there any particular advantages for you?

For me personally this has also lead to an increase in salary, although again this may be down to my extended practice but I do feel that registration has made it possibly in the first place

Paramedics now can compete directly for advanced jobs within the National Health Service

Having a registration number has added security for any employer, it means that the individual is largely responsible for his/her own practice.

I do not think I benefited.

The implementation of regulation by the Health Professions Council was not smooth

What about the downsides?

I cannot think of any real downsides to registration personally, we had the initial gripes like the cost of it all, big brother watching us etc but this has passed now and most paramedics I know see registration as an integral part of the profession.

The cost was a drawback and the costs of the registration fee rose quite steeply in the first three years from 30-120 pounds sterling.

The Health Professional Council2 that was the responsible body for overseeing all aspects of regulation did not seem to be very informed on emergency services. At times their administration processes were not good.

It did mean another group, other than the employer was involved in investigating complaints.

The employer could also pass over their disciplinary tasks to another body and this mean paramedics going though the disciplinary processes felt very alone. This was a real issue.

Also it was not clear that indemnity insurance purchased by employers would assist ambulance officers going through a complaints???

Were all ambulance officers covered by the regulation? (In NZ the debate is whether regulation should only cover Intermediate Life Support and Advanced Life Support or all Practice Levels, including Basic Life Support as well. Do you have views on this?)

We only have two grades of ambulance officer in the UK, Emergency Medical Technician (EMT) and Paramedic (ICP equivalent).

The EMT is likely to be obsolete within a few years and so registration is probably best reserved for paramedics. That said you have ambulance officers in New Zealand at levels below ICP using advanced skills so maybe your registration would need to include them also?

If you reserve it solely for ICP’s I should imagine there would be an increase in applications for ICP training!!!

I think at the end of the day if regulation is to be introduced in New Zealand all clinical personnel should be covered , if not it could lead to different groups being paid differently or being disciplined differently

Do you think patients are any safer now than before and if so why?

The obvious benefit to the public is increased accountability for the individual paramedic. Prior to registration and closure of title the paramedic would answer only to his/ her employing ambulance service with regards to complaints etc. This “in house” format meant that on occasion there was no real learning outcome to be had from complaints.

One is still open to “in house” investigation and there is a place for this but certainly issues of misconduct and negligence etc are dealt with severely by the HPC and this is all made public, just as it would be for a nurse or a doctor.

It has also lead to better CPD for us and this has benefited the public by way of greater confidence in clinical skills by paramedics.

I believe that it has also made the public feel more confident in us as professionals, unlike the old days where any part time first aider at a school fete could call themselves a paramedic!

The new Patients Charter meant that complaints had to be investigated by the regulator.

Has it improved training of paramedics?

The education within my ambulance service has changed dramatically for the better over the last few years, I am sure that registration has played a part in this. The HPC have laid down the framework for CPD and in fact it is this that forms the bulk of the work when we re-register every two years. Because of this training has improved.

Has it lead to new roles for paramedics?3

My Emergency Care Practitioner qualification is not mentioned as part of my registration but we are working towards speciality add ons for our titles so that one day my registration may read something like “Specialist Paramedic/ Emergency Care Practitioner”.

It did mean development in some areas such as clinical paramedic specialists so did give a possible different career path.

Was it a good thing for the ambulance services?

In the UK this year the department of health is looking at opening up prescribing rights for extended paramedics. This is likely to be the Emergency Care Practitioner and would put us in line with our Nurse Practitioner colleagues. Registration would be absolutely essential for this milestone skill.

Do other health services now see ambulance officers in a different light i.e. more like fellow heath professional not just people who transport patients to hospitals?

For the first time it has put us on a level footing with such groups with regards to general credibility. This has lead to paramedics (albeit with extended scope of practice like Emergency Care Practitioner) being able to gain employment away from the ambulance service in areas traditionally reserved for advanced nurses or doctors.

I do not think paramedics were viewed any differently to other health professionals. At times the sector is defined as an essential service- at other times as a health service.

1 In the UK work is being forwarded enabling paramedics to prescribe. In New Zealand an application would have to be made to the New Prescribers Advisory Committee for authority to independently prescribe; this ability only applies to registered health practitioners. Authority is usually limited to certain defined medicines

2The Health Professions Council is the regulatory body in the United Kingdom responsible for regulation of 15 professions. In New Zealand an regulatory group is usually regulates one profession or 2-3 very closely related professions, that said the administration of most of the smaller RAs is done by a joint secretariat.

3There has been development of new roles such as Emergency Care Practitioner in the UK.