Model of rotational working aims to stop ambulance trusts spinning out of control

Ambulance services have to change the way they work to meet the increasing demand on our services.

This was the message to the latest Council meeting of the Association of Ambulance Chief Executives from Andy Swinburn, Assistant Director of Paramedicine at the Welsh Ambulance Service (WAS).

He told the senior leaders of every NHS ambulance service in the UK that recruiting extra paramedics and buying more vehicles would not ease the pressure on our services. Andy told the July meeting of the NHS Ambulance Chairs and Chief Executives;

We are now two years in to an 18 year period when the baby boomers are turning 70 and relying more on health services. We cannot grow our way out of this problem with conventional resources. We need strategic change.

He added that research by the Royal College of GPs also showed that these pressures were being felt in primary care as well. Most patients are elderly with complex conditions and multiple comorbidities.

He illustrated how, in Wales, ambulance calls from healthcare professionals increased during the week, but not at weekends; and that this rise in demand from healthcare professionals had a significant impact on response times for amber category cases; but not the red cases categorised as potentially life-threatening.

GPs are seeking to address this demand by recruiting more paramedics, although Andy told the AACE Council that the development of a rotational paramedic system in Wales had kept trained and experienced staff in the ambulance service while simultaneously supporting GPs and primary care.

He said this had been achieved by using advanced paramedic practitioners, educated to Masters’ Degree level, being tasked to ambulance incidents where they were most likely to avoid conveyance to hospital. These were not the low acuity cases nor potentially life-threatening incidents, but the vast majority of amber category calls received by WAS. He added:

They have the greatest impact responding to patients calling about chest pains, difficulty breathing and abdo pain because of their ability to absorb risk.

This skill and risk appetite came from the rotation of advanced practitioners working in primary care and out-of-hours centres and then bringing these skills back to WAS while working on rapid response cars. The third element of their rotation was in control, where advanced practitioners also worked to dispatch their colleagues in rapid response vehicles because they could best identify and match advanced practitioners to patient need at the point of the 999 call assessment.

In a North Wales pilot of the rotational paramedic system, just 30% of patients went to ED while another 33% were managed without any further referral. Using this data to forecast future trends, Andy said that ambulance conveyance to hospital would significantly drop by 2023 in comparison with an unsustainable increase in hospital conveyance if WAS did nothing.

He concluded to the AACE Council:

If we don’t collaborate to work with primary care in this way, then they will simply take our staff from us.

You can hear more about how ambulance services in the four nations of the UK are transforming in this podcast.