New role has ‘phenomenal’ effect on Emergency Departments, improving patient experience and utilising the NHS workforce more effectively

Picture the scene: an elderly, frail man with advanced dementia falls at his nursing home. Bleeding heavily and in shock, he needs urgent healthcare. Staff ring ‘999’. An Emergency Care Practitioner (ECP) arrives, speedily assesses the situation, cleans, and stitches the wound, and calmly reassures the patient as his familiar carers remain close at hand. Satisfactorily treated, the elderly man is led away to rest in his room having never had to visit an Emergency Department.

This true scenario is now being replicated as the role of ECP is rolled out nationwide, first piloted by South Central Ambulance Service NHS Foundation Trust (SCAS). Not only is patients’ experience greatly improved, the use of ECPs in primary and secondary healthcare significantly reduces costs and relieves pressure on the organisation.

Benefits

• 30% fewer patients transferred to an emergency department
• 48% of elderly patients suffering a fall did not need to be admitted to an emergency department
• More cost-effective use of staff – an ECP attending a 999 call costs much less than sending an ambulance
• Increased workforce capacity
• Increased patient satisfaction – evidence shows that patients prefer to be treated close to or in their own homes
• Speedy, effective service – fewer clinical and administrative processes
• Personalised service – ECPs respond to individual care needs
• Clearly defined competences give staff the right skills and confidence to make safe clinical decisions
• Opportunity to develop new skills and expertise
• Opportunities for career progression

“The effect of using ECPs has been phenomenal. In some areas of the Trust up to 90% of 999 cases are discharged without needing further emergency care. Emergency departments are the lynchpin of an acute trust, so reducing the pressure on a unit in this way has a major beneficial impact on the whole hospital.”

Mark Ainsworth-Smith, Consultant ECP, South Central Ambulance Service NHS Trust

Current statistics show that over three quarters (77%) of 999 calls result in admission to an emergency department (ED). Health sector employers face several pressures around urgent, unscheduled care including the drive to lower waiting times in emergency departments. The imperative to develop a more flexible model of care was clear.

Our expert workforce team develop and manage a portfolio of national workforce competences that describe the performance criteria, knowledge and understanding required to carry out a specific role effectively.

We worked with several employers to develop a competence framework for an emergency, urgent and unscheduled care, the basis for devising the role and learning programme for emergency care practitioners (ECPs).

The flexibility of the ECP role means they can be used in several ways. In some areas, they attend with rapid response vehicles to all three call categories. Other ambulance trusts use ECPs to staff a clinical support desk that advises on clinical decision making, for example assessing whether it is appropriate to send an ECP colleague to treat at the scene.

ECPs can also support primary care staff, providing home visits, and out-of-hours cover for example. They can also be based in minor injury units or prisons or treat people in their homes or care environments. Consultant ECP Mark Ainsworth-Smith is a keen proponent of using ECPs as widely as possible. He has collated data about the use of the role in his trust, South Central Ambulance Service NHS Trust (SCAS).

This data shows that almost a third (30%) of patients avoided transfer to an emergency department when treated at the scene by an ECP. For all categories of 999 calls, admissions to EDs were significantly reduced. Almost half (48%) of elderly patients suffering a fall and seen by an ECP did not need to be admitted.

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