Hi Rowley

One of the major stumbling blocks we, as ECPs are encountering at present,
is that our role is expanding faster that the policies and historical
practices of the ambulance services.

The impact that ECPs could have in reducing patients attending A&E could,
potentially be profound. A few of the challenges we are facing at present
are..

1. Lack of financial resources to take us 'out-of-the-plan' that is to say
we are no longer considered part of the dynamic 999 cover to meet the 8
minute response times the ambulance services are trying to meet.

2. An American EMS dispatch system that does not have ECP type of work
written into the software - therefore someone dials 999 - who do you send -
ambulance. It is difficult for dispatch to take on responsibilities to
determine an ECP would be the best option based on the laypersons
information given at the time of their stressful situation.

3. ECPs can take on a large percentage of GP calls out of hours and
appropriately determine care pathways including types of ambulances (or not)
used. We need to integrate ECPs into OOH doctor's services and not in tandem
or conflict with them.

4. One of the important factors I feel to effect A&E attendances would be
that ECPs work consistently within A&E units.  John Ryan (Hi John) wrote the
Paramedic Degree programme back in 1992-95 and had PECs (now ECPs) working
in their own clinic in A&E and responding from the department. PECs and ECPs
are paramedics and nurses working across the boundaries of professions in
and out of hospital.

I know that we can reduce A&E visits but need the freedom, education,
clinical and political power to achieve this. The rises we have been seeing
in A&E attendances have and will continue to rise until we, as an industry,
pour loads of money into these systems and formalise working practices which
are integrated with the GP OOH and the A&E depts.

As a side issue and based on recent media coverage... I would say for those
who are concerned about ECPs 'taking on GP services'. Paramedics and nurses
alike practice within our scope of practice (some would say comfort zone).
If we have any concerns, we always refer back to GPs or the A&E departments.
For this reason the perception of ECPs potentially being unsafe as pseudo
GPs doesn't hold water as we would never place ourselves in a position to
jeopardise our career.

Regards
Mike

-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Rowley Cottingham
Sent: 30 June 2005 20:34
To: [log in to unmask]
Subject: Re: Taking health care to the patient: Transforming NHS Ambulance
Services

I have looked at our data since April and compared it with the same time
last year. Overall, we are 7% up on last year's attendances and last week
was 18.9% up. I hear that colleagues around the country are seeing similar
rises. Much of the rise is primary care work, particularly at weekends.

The primary care initiatives are supposed to prevent 2.5% of attendances
this year.

Best wishes


Rowley.



-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Vic
Sent: 30 June 2005 16:08
To: [log in to unmask]
Subject: Re: Taking health care to the patient: Transforming NHS Ambulance
Services


Perhaps I'm just very cynical but I think it's politicians trying to get
popularity and cheap care all in one. Trouble is when politicians interfere
in anything they mess it up...

Vic Calland

-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Andrew Webster
Sent: 30 June 2005 13:26
To: [log in to unmask]
Subject: Taking health care to the patient: Transforming NHS Ambulance
Services

It may just be a slightly cynical thought but will more ECP's going out to
the home actually save money?

As we have seen with NHS direct/ WIC etc it tends to increase demand without
any real proof of impacting on A&E services.

A "medic" coming to your house may be an attractive option for many people,
but it may turn out to cost more. People who previously would have gone to a
WIC/MIU will instead call 999 to wait for their ECP to turn up in their
shiny  MPV.

GP's have moved away from doing house visits as far as possible because it
takes more time to drive from house to house compared to seeing
significantly more patients in the GP-COOP centre. There are also the issues
of seeing patients in an inadequate household setting and the security
issues of working on their own.

Perhaps it would be more cost effective to hire a driver to pick up patients
in an MPV to deliver to a GP COOP or A&E department. If the ambulance
control had misclassified the call they could dial 999 to get a 8 minute
response.





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