Paramedics in the United Kingdom

In the United Kingdom the term paramedic is protected by law and only applies to ambulance practitioners who are able to achieve and maintain the strict standards established by a statutory body. The Health Professions Council (HPC) requires Paramedics to enter a register before being allowed to work autonomously. It sets the profession’s standards of proficiency and expects registrants to work by codes of ethics, conduct and performance.

Paramedics are expected to work utilising their own clinical knowledge to make decisions, many employers utilise clinical guidelines to make this easier. These vary throughout the country but increasingly are being brought into line with national guidelines. The Joint Royal Colleges Ambulance Liaison Committee (JRCALC), a collection of professionals from the U.K.’s Medical, Nursing, and ambulance communities, produce these guidelines bi-annually since 2000. This group reviews its advice based on the principles of evidence based medicine and best practice.

Unlike other countries, there is only one legal level of practitioner. However, many paramedics undertake further training or higher educational programmes in order to work as advanced practitioners. Community Paramedics, Critical Care Paramedics and emergency care practitioners (ECPs) vary in the scope of their practice throughout the country but can be found offering unscheduled care in the community in lieu of G.P. visits. They are also employed to act as Forensic Medical Examiners FMEs within the UK instead of GPs

Qualifications
Traditionally the only route to becoming a paramedic was to join an NHS ambulance service and work towards the position from non-emergency patient transport roles through to the emergency division. After qualifying and working as an ambulance technician for a period, it was possible to internally apply for paramedic training. Although offered at ambulance service training departments, the curriculum and certification were awarded by a private company called IHCD. Such paramedic training was usually a 10 week course with some of this time spent in a hospital operating theatre, assisting the anaesthetist and performing airway management techniques. Completion of the course allowed the Paramedic to register with the then legislative body (state registration).

It was nearly impossible for non-NHS employees to access such courses, and many private ambulance companies provided their own training. However, lack of recognition by the regulatory body for such training created a problem. This was compounded by paramedical staff leaving the armed forces who found their training unrecognised. Eventually the term Paramedic was used by variety of people with varying levels of ability. After the incorporation of the H.P.C. the paramedic became legally defined and private and military ambulance staff were given an opportunity to have their training and experience reviewed (grand parenting) against the new standards. This allowed many to register.

Eventually the IHCD began to accredit non-NHS training establishments, allowing them to teach their curriculum. In the mid 1990s some universities started to offer para-medicine diplomas and degrees, in association with local Ambulance Trusts. These incorporated the IHCD curriculum and allowed registration. Later, the Health Professions Council (HPC) and British Paramedic Association (BPA) defined the educational standards required to register, removing the requirement for the IHCD material to be the core of such programmes. Only recognised courses will lead to registration however.

The higher educational route is still considered controversial, with some more experienced ambulance staff arguing that such a fast-track approach misses the experience of PTS where recruits learn vital interpersonal skills, although there is no evidence to support this. However many university educated Paramedics are now working for the country's ambulance services in various posts. Soon the higher education route will be the only entry option into this profession to bring it inline with the other allied health professions. Jobs are also now being advertised for 'Graduate only' Paramedics.

Employment
The NHS employs the majority of Paramedics, usually in the role of clinical lead on accident and emergency ambulances. However, some are employed by the NHS in providing other services such as G.P. practice based roles, community unscheduled care provision, and within minor injury units. Private sector paramedics are often found providing medical services at large public events, at remote industrial sites, as lecturers and trainers, or increasingly as contractors working on behalf of the NHS in accident and emergency work. Increasingly Paramedics are being tasked to work on Fast Response Cars to respond to accidents and emergencies.

A Number of private ambulance services also employ Paramedics, with many of these moving into specific disciplines to allow them to compete with the NHS. Critical Care Transfer is one such niche in which private companies are flourishing.

Professional Organisations
The British Paramedic Association is the Paramedic's professional body within the U.K. It was formed relatively soon after the H.P.C.'s incorporation but due to Government pressure rather than peer demand. It was the only profession regulated by the H.P.C. without such a body and this situation was deemed unallowable. It was important the profession could maintain self regulation responsibilities for standards and education. At the time Paramedics were still struggling with what it means to be a professional rather than a vocational worker and the B.P.A. was eyed with some suspicion. As a consequence membership is still relatively small compared to the body of the profession as a whole. It does not offer industrial relations or other services normally associated with trade unions. Now does it offer the support of comparable organisations such as the RCN.