Advanced paramedics in England will be able to prescribe medicines to people who do not need hospital treatment, under new laws starting on Sunday.
Who will be able to prescribe?
Advanced Paramedics – those undertaking or having completed a Master’s-level (Level 7) qualification – will be allowed to complete a prescribing module, if their employed role has a need for it (i.e. you must be employed in a prescribing role, e.g. in a GP surgery. An AP cannot complete it if employed in a standard frontline paramedic role where prescribing is not a required qualification).
How does this fit with other professions?
Many other health professions can already prescribe. Nurses led the way, followed by various others including radiographers and chiropodists.
Will this mean frontline paramedics will prescribe?
No. To register, frontline paramedics have only completed a Bachelor’s-level qualification (Level 6) (from 2021), a Foundation level qualification (currently) or an in-work IHCD qualification (in the past), and therefore will not be able to apply for the prescribing module.
Why are paramedics being given the ability to prescribe?
Paramedics don’t just work in ambulances. We also work in GP surgeries, A&Es, walk-in centres, and Intensive Care Units across the country. Many of these roles are limited because the Advanced Paramedic, often employed alongside Advanced Nurses or other Advanded Allied Health Professionals, cannot prescribe, unlike their nurse & AHP counterparts. The change to the law will allow these to work equally to other professions, and will expand the number of range of jobs Paramedics can do (e.g. why employ an Advanced Paramedic who can’t prescribe, when you can employ an Advanced Nurse who can?).
Will there be any prescribing in the Ambulance setting?
Paramedic Prescribing is up to each Ambulance Service Trust to implement. There is certainly scope for benefiting the patient & the system if Advanced Paramedics are able to support frontline crews with prescribing skills. There are many cases where patients are taken to hospital or referred to the out-of-hours GP for a simple prescription that could, now, be handled by the ambulance service.
Is prescribing just for non-emergency cases?
No. Paramedic Prescribing will also widen the range of drugs paramedics are able to administer in an emergency when supported by an Advanced Paramedic. This too will be up to each Ambulance Service Trust to implement.
Won’t people just call for an ambulance for a prescription because its quicker than waiting to see a GP?
This question assumes that ambulances currently only go to emergency cases. This isn’t true, and we already attend many non-emergency cases that could/should be dealt with outside of the ambulance service. This has become the case through a combination of factors discussed in another article. Many of these patients, now they have entered an ambulance system ill-equipped and ill-trained to deal with their non-emergency health condition, are fed into the out of hours GP or hospital system.
Giving the ambulance service the ability to prescribe will not reduce the amount of non-emergency cases we attend, but it will reduce the onward burden of these cases to other health systems.
Furthermore, sometimes patients have multiple needs, some of which are urgent and some non-urgent, which may all contribute to an ambulance call-out. For example, a patient may have fallen and is unable to get up – a paramedic’s bread & butter – but the patient may also have an underlying chest infection or unmanaged chronic pain, which could have caused the fall.
Say you’re wrong. What happens if calls for non-urgent cases do increase?
The underlying issue here is that the Ambulance Services are already stretched between trying to provide quality care to both emergency and non-emergency groups. The concern highlighted in this question is that this tension may increase further if the patients begin to use the ambulance service in order to obtain a prescription quicker.
The solution is not to stop ambulance services from prescribing in order to manage the tension, but to look at the systems that bring about the tension in the first place.
Here I wrote how current ambulance services might overhaul the system by providing only emergency care, while another group of paramedics, either still employed by the ambulance service but with exclusive resources, or employed by new non-emergency ambulance services or by GP surgeries themselves, could handle non-emergency care.
Paramedic Prescribing increases the ambulance services ability to provide 24 hour care in the community, independent of other services, across a whole range of acuities.
This provides a potential solution to the increasing difficulty found by General Practitioners to be able to afford to conduct home visits and to provide out of hours care. Ambulance Services have held GP visits & OOH GP contracts in the past, and have delivered well. As long as we ensure that this doesn’t impact the emergency care delivery, ambulance services could reshape the landscape of care in the community.
Where can I find out more?
The College of Paramedics has led the campaign for paramedic prescribing, and has a lot of good information and documents on their website.