Specially trained paramedics to assess whether they can treat patients out of hospital in plan to improve 999 response rates
East Midlands ambulance service trust is piloting a new project that allows specially trained paramedics to decide whether patients should be treated at home, or referred to a GP or walk-in centre.
The trial is part of the trust's plans to keep people out of hospital where possible in an effort to cut the strain on A&E, and help improve ambulance response rates to emergency calls.
If rolled out fully, emergency care practitioners – paramedics with an extended set of university qualifications – would view 999 calls on a computer-aided dispatch system at the trust's emergency operation centre in Lincoln, and select the jobs that they believe would normally result in an ambulance taking the patient to accident and emergency.
They would then respond to the call and decide whether the patient needed to be taken to hospital, or if an alternative option was appropriate, such as being treated on the spot or referred elsewhere, for example as an out-of-hours GP. Under normal circumstances, the trust would respond to a job with an ambulance crew, which would probably take a person to A&E straight away without any other considerations.
Pete Jones, the assistant director of operations in Lincolnshire for the trust, told the Guardian that automatically taking people to hospital could no longer be the default option, due to unprecedented pressures on A&E departments.
"The future is not bright in terms of commissioning and extra money. We can't just keep adding to the bill in terms of resources. What we've got to start doing is taking patients off the front end of that list, and start treating them in the community and keep them away from the hospitals if possible," he said.
Around 20 ECPs are taking part in the trust's pilot, which is being funded by NHS Lincolnshire. Jones said meeting response time targets for 999 calls was also an important consideration when launching the scheme.
"The government sets these targets and we have to reach them, and that's what we have to aspire to, but from our point of view what we're trying to do is concentrate on the quality of care and patient safety. But these targets do have to be achieved. It's a by-product, and I don't like it, but it's there and we've got to do it," he explained.
Ambulances are expected to respond to life-threatening emergencies within eight minutes under the government's current rules. This is an area the trust is trying to improve after councillors in Lincolnshire expressed concerns about East Midlands ambulance service's response times at a recent cabinet meeting.
Jones stressed that the trust was doing its best in this area, but said it faces the additional burden of around 4.5 million tourists visiting the area each year.
"We're not funded for that in any big way. The emergency ambulance cost adjustment payment that is made to the division is about £700,000 each year and that doesn't even begin to bridge that gap," said Jones.
"These people bring with them their requirements for pharmacies. In the summer, particularly when it's busy out in the east coast, we set up triage centres on weekends just to try and alleviate the necessity to trundle up and down the road to hospital."
Jones is hopeful that the new system could help the trust become more efficient, and plans to show the benefits of the project to clinical commissioning groups and service providers once the scheme finishes at the end of March. If successful, the pilot could be rolled out across Lincolnshire, with ECPs potentially gaining additional responsibilities, such as giving out antibiotics for chest infections.
"If we've got a framework around this concept of clinicians going out into the community … and they're keeping patients in the community and treating them at home or in their workplace, that's where we want to go with this," he added. Guardian Professional.