Calls to emergency control rooms continue to rise by between 7% and 15% each year, and each call-out costs the ambulance service £120. Many 999 calls are not true medical emergencies, coming from patients with relatively minor medical problems or with social needs.
To meet the increase in call-outs, Skills for Health has introduced a new role to support Primary Care Trust (PCT) emergency response teams.
Emergency care practitioners (ECPs) were introduced to the NHS in 2004. There are now nearly 650 working in 41 PCTs throughout the UK, delivering care and treatment within pre-hospital, primary and acute care settings. They provide rapid response to minor injuries in different environments: in general practice, minor injuries units, out-of-hours services, rapid response, walk-in centres, and busy accident and emergency (A&E) departments.
The Career Framework Team in Skills for Health has developed the role of the ECP to cover competencies that include providing emergency assessment, diagnosis, treatment and aftercare.
ECPs complete 1,000 hours of designated study time, of which a minimum of 300 hours is designated as theory learning (delivered at a minimum standard of degree level) and 700 are clinical learning hours in appropriate clinical settings. This enables them to practice as part of the clinical team, within a range of primary and secondary healthcare settings.
Sending an ECP to respond to a call costs £80, saving the NHS £40 per call-out. It is also hoped that by using ECPs, 70% to 80% of patient visits to A&E could be treated elsewhere, saving the NHS a further £75 per patient. The use of ECPs also means the ambulance service should be more responsive to those patients with acute or life-threatening needs.
Within the next five years, there will be between 2,000 and 3,000 ECPs in the UK, rising to 5,000 in 10 years. Currently, the Department of Health (DoH) is rewriting its Urgent Care Policy for England and other areas, and further development of the ECP role will depend on how emergency patient care is structured in this policy. In the meantime, ECPs will continue to provide essential support to emergency teams and generate cost savings for the NHS.
ECPs are currently being recruited from nursing, paramedic or other regulated healthcare professionals who have completed the competency-based education programme developed by the NHS Modernisation Agency’s Changing Workforce Programme in partnership with Skills for Health.
There are now 215 ECPs undertaking programmes at 17 higher education institutions and, in two years, it is envisaged that there will be a direct entry available for school-leavers.
Hundreds of nationally qualified clinicians will emerge with the knowledge, skills and professional behaviours to function as an ECP and the personal and intellectual attributes necessary for life-long professional development.
Hull PCT, facing a shortfall in GPs due to the high number of single-handed GPs approaching retirement, has employed ECPs in its area since November 2004. Nursing and residential care homes now contact ECPs directly for patient assessment to medical interventions, such as X-ray requests and stitching wounds. The ECPs also support custody nurses in police charge cells and healthcare staff in prisons.
Other parties involved in promoting the use of ECPs include the NHS Modernisation Agency, the DoH, 22 higher education institutions, 12 ambulance services, 11 strategic health authorities and associated PCTs.
1 In Avon, using ECPs has saved the county’s employers and associated health communities more than £84,000 per ECP, which is more than twice their employment costs.
2 If all ECPs deliver this level of benefit, it would equate to national efficiency savings of £51m based on last year’s costs.
3 In Hull, only 309 patients out of 1,614 seen by ECPs between January and July 2006 were referred to Hull Royal Infirmary’s A&E, paediatric or acute assessment units.
“ECPs are not only carrying out a valuable service in helping to look after the community, but have taken the strain off the NHS. It is an example of what can be achieved with common sense, assessing what’s needed and giving people the opportunity to use their skills and knowledge outside the box.”
Julie Turner, assistant director of operations, Hull Primary Care Trust