Analysis

How new laws on paramedics prescribing drugs could help emergency nurses

Health chiefs says the changes could have a beneficial impact on the treatment of time-critical and life-threatening conditions

Health chiefs says the changes could have a beneficial impact on the treatment of time-critical and life-threatening conditions


Picture: iStock

Emergency nurses have welcomed new laws allowing advanced paramedics to prescribe drugs as an opportunity to improve care for patients.

The legislation, which came into effect on 1 April, will speed up access to treatment and prevent unnecessary visits to overstretched emergency departments (EDs) and general practices, NHS England says.

70%

of patients seen by advanced paramedics do not need be taken to hospital according to NHS England

It means advanced paramedics visiting patients’ homes and working in EDs or general practices will be able to prescribe medication in the same way that nurse prescribers can.

Currently, advanced paramedics have had to use patient group directions to offer a limited number of medications or find a doctor to sign off on a prescription. All paramedics can administer medication from a limited list in the event of an emergency, including adrenaline, morphine and glucose.

Up to seven out of ten patients seen by advanced paramedics may need help but do not necessarily need to go to hospital, NHS England says. This often includes older patients in need of antibiotics, those with back pain requiring pain relief and asthma patients who could be helped with oral steroids.

More than 90% of responses to an NHS England consultation in 2015 backed the changes.

New powers could save lives

The new powers for paramedics have been welcomed by the health charities The Patients Association and the UK Sepsis Trust, which said the move could save lives.

There are now hopes that at least 700 paramedics will be trained to prescribe in the next five years.

The first cohort should be able to join non-medical prescribing courses beginning in September, with the expectation that they will finish around next Easter, according to the College of Paramedics.

Janet Youd, emergency nurse consultant at Calderdale and Huddersfield NHS Foundation Trust and chair of the RCN Emergency Care Association, says allowing paramedics to join the professions who can prescribe, which includes nurses, physiotherapists, radiotherapists and pharmacists, is a welcome and overdue step.

Paramedics can already be credentialed in the same way as nurses through the emergency care advanced clinical practitioners programme run by the Royal College of Emergency Medicine, but legal restrictions previously prevented them completing the prescribing elements.

Ms Youd says that two paramedics are currently training in advanced care in her emergency department and are a vital part of the multidisciplinary ED team.

Multi-professional workforce

‘Paramedics can already work at an advanced practice level, just as advanced nurses do who can prescribe perfectly safely,’ she says. ‘Advanced paramedics already examine, assess, diagnose and recommend treatment plans. This change will help multi-professional workforce development within the ED.

'We are going beyond doctors and nurses, and using physios, pharmacists and paramedics. It benefits the patient that we have a workforce who are competent to be able to take senior clinical decisions early, rather than delaying.’

13%

of hospital admissions can be reduced by following care from an advanced paramedic
(NICE 2018)

Having a truly multi-professional workforce enhances care by bringing in all the different expertise from the different professions, she says. ‘Paramedics bring in all their skills and knowledge on prehospital care and assessment, and nurses bring a holistic knowledge, rather than just focusing on a medical model.’

The National Institute for Health and Care Excellence (NICE) has also recognised the value of advanced paramedics, and called for more to be recruited to ease pressure on EDs in new guidance published in March. Evidence reviewed by NICE shows that using advanced paramedic practitioners (APPs) can reduce hospital admissions by 13% compared with standard paramedics.

APPs can treat patients in the community, refer them to a GP or decide if they should go to hospital. They can be used on the ground or by sharing their expertise over the phone.

A 2007 study by Malcolm Wollard suggested that for each APP, the NHS could save up to £72,000 a year.

Clearer lines

Allowing paramedics to prescribe also creates clearer lines of responsibilities for the prescribing of medicines, NHS England says.

NHS England chief executive Simon Stevens said the legal change was an important part of bringing more care into people’s homes.

‘Home visits by advanced paramedics and increasing use of clinical pharmacists and mental health therapists are among the practical ways the health service continues to innovate and adapt to the changing needs of patients and the population,’ he says.

The benefit to patients with time-critical and life-threatening sepsis was also pointed out.

UK Sepsis Trust chief executive Ron Daniels says: ‘Paramedics who are responsibly trained and able to make referrals in more complex cases will deliver much-needed care sooner and closer to home, and have the potential to radically improve outcomes for those with sepsis.’

College of Paramedics medicine and prescribing lead Andy Collen says that paramedics are increasingly working in a wide range of settings including EDs, critical and primary care.

Support from nurses and other colleagues will be vital to paramedics during and after their prescribing qualification, he says.

‘As a profession we value working alongside nurses, and allied health professionals and nurses will be able to support and supervise paramedics in the future, particularly in the early days when we won’t have our own critical mass.’

‘Prescribing is going to be an essential part of our work'

North West Ambulance Service NHS Trust advanced paramedic Leigh Cartwright (pictured) says that prescribing will be a vital tool to improve care for patients.

Mr Cartwright is one of more than 30 advanced paramedics at the trust who attend more complex patients, major trauma cases and advise the call centre on which patients need more rapid attention.

He plans to take a prescribing course as soon as possible to supplement his MSc in advanced practice.

‘We try to leave as many patients as we can at home, to get them the right care in the right place,’ he says. ‘Prescribing is going to be an essential part of our work, not just in pre-hospital care, but also our work in urgent care centres and emergency departments.’

It will particularly help in cases where patients are well enough to stay at home and need medication, Mr Cartwright, who works in Greater Manchester, says.

‘Within the community, when I recognise that a patient needs antibiotics, we cannot prescribe so I have to try to get their doctor to visit or get them to the doctor for a prescription, and if I can’t do that I have to take them to the hospital,’ he says. ‘It will allow us to see more patients, and if we can treat people at home without requiring them to come in we can reduce delays and release ambulances faster.’

 

Find out more

Woolard M (2007) Paramedic practitioners and emergency admissions

National Institute for Health and Care Excellence (2018) Emergency and acute medical care in over 16s: service delivery and organisation


Erin Dean is a freelance health writer

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