South Yorkshire Ambulance Service NHS Trust

Ambulance services in South Yorkshire have developed and implemented an Emergency Care Practitioner role which has led to a reduction in attendances and admittance to hospital and thereby released pressure on acute hospital services.

Background
The Emergency Care Practitioner (ECP) is a new role developed and introduced across South Yorkshire by South Yorkshire Ambulance Service in collaboration with local hospitals, PCTs and the wider healthcare community.

It provides a new role and model for urgent response to particular emergencies by providing enhanced skills to ECP personnel who can then treat particular patients in their home or the community – with the ability to quickly transport them to hospital or refer them to other services if needed. A typical example would be a situation in which a person was experiencing breathing difficulties; an ECP would be able to assess and, where possible, treat the patient in their home and avoid hospital admission.

The ECP role
According to Skills for Health an ECP is ‘an allied healthcare professional who works to a medical model, with the attitude, skills and knowledge base to deliver holistic care and treatment within the pre-hospital, primary care and general practice environment with a broadly defined level of autonomy’.

The objective of developing the new role was to address the growing demands on all aspects of healthcare by providing a new form of emergency service that would:

• Bring about a reduction in hospital attendance and admission rates by tackling emergency cases in the community that would have typically gone to hospital
• Meet a desire to do things differently in the ambulance service and introduce new roles
• Give an opportunity to draw on the benefits of closer working between ambulance services and primary and secondary care.

The challenge
The challenge with introducing this new role was gaining acceptance of the role into the healthcare community and creating the right impression of the role within the ambulance service. It was important to make the ECP role a recognised part of the ambulance service to outside agencies and particularly ambulance crews to facilitate effective working.

This issue was addressed by tacking a different, and more focussed, approach with protocols and referral pathways.

PCTs were also facing their own challenges providing unscheduled care, so it was important to retain the focus of the original objective for the development of this role to ensure that the ECPs were not used to plug gaps in other areas of need within the acute sector.

"We went into this with our eyes open and had identified what we perceived to be the benefits from the introduction of this role," says Dr James Gray from South Yorkshire Ambulance Service, "Ultimately, the aim was to improve the quality of patient care and provide the most appropriate patient assessment and treatment at the point of access."

Positive Outcomes
"There have been positive responses to this role from both health and social care and this has been demonstrated by a willingness to open up patient pathways," explains Dr Gray, "This has resulted in an overall figure for avoided attendances or admissions of up to 60% (based upon 950-1050 patients per month). Patient satisfaction has been consistently high and those patients seen by ECPs tend to have fewer investigations performed on them."

Academic research from the School of Health and Related Research (ScHARR) in Sheffield found that whilst 69.9% of patients treated by the ECP had contact with healthcare in the subsequent 28 days, 90% of these were community services rather than secondary care. As a result of this the ECP role had a positive impact on the pressures facing junior doctors in acute care and as such specifically supports WTD compliance aims. Demand for unscheduled care has been increasing by up to 10% annually so the introduction of the ECP role will help to stem the increase.

Five key lessons from South Yorkshire

1. Engage- collaborative working is important as is ensuring that you have buy in from stakeholders.

2. Initiation – be clear about how the project will be initiated, in this case, clarity was needed around the referral pathway.

3. Agreement- don’t rely on good will, formalise agreements.

4. Recruitment – Be clear about where and how the recruitment will take place.

5. Focus – Retain the focus of the original objective whilst retaining an awareness of the pressures of other organisations.

Contacts: - Dr James Gray – Yorkshire Ambulance Service (South)