College of Paramedics Executive Officer, Liz Harris takes a look at the recent HCPC 'People Like Us?' report and considers why so many paramedics self refer.
Why does the paramedic profession have a disproportionately high number of HCPC fitness to practise cases against it when compared to the numbers of paramedics on the register? The ‘People Like Us?’ report was produced following research commissioned by the HCPC in response to several years of high numbers of fitness to practise cases against paramedics. In 2016-17 paramedics made up 7% of the Register and 13% of fitness to practise cases. You may think that these individuals are exceptions within the profession, that they differ in terms of their motives or behaviours but in fact they are just like us. They are people like us. The vast majority of referrals where ‘one offs’, did not result in any harm to a patient and only 18% of referrals came from complaints from the public. Public perceptions and changing expectations were factors highlighted in the report as reasons for referrals. These factors are also linked to the nature of paramedic practice, paramedics deal with people in crisis, at their most vulnerable time and in unpredictable situations.
In the sample within this research, 46% of the HCPC referrals came from self-referral compared to an average of 26% across all 16 professions. 84% of the paramedic self-referrals resulted in no further action by the regulator. These figures suggest that the disproportionality highlighted in this research originates from a high number of self-referrals that do not meet the HCPC standards of acceptance for an allegation, rather than an indication of clinician impairment of competence. This statistic is at first sight welcoming, but on deeper consideration it is clear that a HCPC referral, whatever the outcome is most probably significantly psychologically distressing for the individual and their family.
It is important for us to remember the history of the paramedic profession when discussing the findings within this report. The professionalisation of paramedics began to occur following introduction of registration. Regulation of paramedics by the Council of Professionals Supplementary to Medicine began in 2000 (and subsequently by the then Health Professions Council (HCPC) in 2003. This regulation fuelled the formation of the paramedic professional body, the British Paramedic Association in 2001 with a name change to College of Paramedics in 2004. This situation is unlike some of the other professions regulated by the HCPC who had already established their professional status during many preceding years.
In the early years of registration, paramedics were not prepared and fully informed of the processes and consequences of professional regulation. This combined with the effects of the cultures highlighted within the report has led to consequences that have perpetuated over the years and are still apparent today. These consequences are detailed in the full report through narrative accounts from working paramedics describing ‘fear of the HCPC’, a ‘big stick’ approach by Ambulance Services to tackling issues and complaints with the threat of ‘you better self-refer or else you’ll be struck off’ ringing true for many in the profession. These accounts point towards a notion that the paramedic profession could have had a much better relationship with the HCPC if Ambulance Service culture had been different.
Ambulance Services could increase their support for paramedics in several key professional areas; complaints and investigation processes are a notoriously difficult time for paramedics to navigate, access to all appropriate documentation and expert statement writing guidance is vital; fitness to practice processes can be long and arduous and impact negatively upon the individual’s confidence; continuing to work whether under sanction or not can be clinically, ethically and emotionally very challenging; any clinical development following a return to practice must be robust and effective. Adequate professional and psychological support for paramedics and other frontline ambulance clinicians must make its way right to the frontline where it is needed most.
The College of Paramedics welcomes the findings within this report and thanks the HCPC for its commissioning. Not only because now the situation is highlighted through a robust piece of research, we can look to understand the complex reasons and begin to educate to dispel the myths that still prevail and work towards reducing the number of unnecessary self-referrals that paramedics make. This report marks a moment in time to move away from what prevailed before and towards a different and much better relationship with our regulator and the employers of paramedics. The findings and recommendations should also provide further impetus for ambulance services developing more positive and transparent approaches to clinical issues and complaints with patient safety and professional learning at the core of any investigative process.
Should you have any further questions or suggestions on how to tackle some of the points highlighted please email firstname.lastname@example.org
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