I agree there will always be one practitioner that is a wildcard and
potentially mess it all up - hopefully it won't be me!
I agree with your sentiments - I wonder if the government put as much money
into GP resources as they are have and are going to do with ECPs if the
outcomes in patient movements and appropriateness of care would be more
useful and cheaper in the long run. I honestly don't know.
On the subject of research - it would be nice to think that we would be big
enough to own up to failures - I don't think we are. More to the point, I
don't think the services have the framework of robust audit and quality
assurance to identify such omissions and failures. This is a shame but those
who want to make this work may be somewhat protective about this new concept
in its infancy.
Alternatively, one could say that bad research is often taken out of
context. You have cited the London Ambulance Paper in your post.
The thing that should come out is that the paramedics had only two days of
training with no consolidation and therefore were unsuitable to be
classified as ECPs who are educated 8 months full time (as a minimum).
Once this is accepted it is easy to take it to the next level that their
assessments and treatment were not that much better than their paramedic
colleagues in the neighbouring station.
Interesting that their on-scene times were only slightly more(a few minutes)
than paramedics. I read into this that they didn't perform a thorough
clinical examination to ECP level.
So, bad outcome research is good, in as much as it gives people like you and
I an opportunity to discuss the whys and wherefores. However, on occasion it
is bad if the media get hold of it, as they would only skim the conclusions
and draw incorrect conclusions.
I too think that we are moving too fast without thinking through the bits
and pieces properly. If I had my way ALL ECPs would be taken through a
minimum of a two year degree course with one years consolidation in GP
surgeries, MIU and A&E depts. Political fashion dictates that it is going
ahead with minimum education and minimum resources.
I hope it doesn't go wrong but I fear the worse.
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Andy Webster
Sent: 01 July 2005 00:29
To: [log in to unmask]
Subject: Re: Taking health care to the patient: Transforming NHS Ambulance
You seem very sensible, in fact most paramedics/ECP's are. But however
as in medicine where you will get doctors of all grades practising
beyond their expertise, you are bound to get ECP acting out their
expertise. There are bound to be problems.
My main problem is in a resource limited system I can not see much money
being saved. At least as much as the Pete Bradeley claims will be seen.
Ambulances can be expensive taxis. But an ECP driving around the city
maybe seeing 5-8 patients in a shift with some being referred on is an
expensive reduplication of services. It is interesting in the case
histories they put in they put in all the positive pieces of research.
But miss out on research that did not show benefit. For example the one
by the London ambulance service which tried to reduce carriage of cat C
patients by empowering a group of paramedics to divert to alternative
providers. I think the end result was no difference compared to standard
practice. It is another example of wholesale changes being brought in
before the pilots have been evaluated. The effectiveness of the
Sheffield paramedic practitioner scheme has not been reported on but we
are moving to nationwide adoption of the changes.
The government likes to make popular changes even if they may not be the
most cost effective.
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