First response: how paramedics are transforming care

The breadth of change across the
new care models programme has involved virtually every health and social care service imaginable. 
The ambulance service has been no exception – here Samantha Jones (@SamanthaJNHS), director of the new care models programme, looks at the role of paramedics in transforming care.

“For anyone who has spent substantial time working in the NHS, the one constant is change. And although many will read that and roll their eyes knowingly, the clarion call for change that was made in the NHS Five Year Forward View in 2014 was a real wake-up call to us all.  The NHS recently published its Next Steps on the Five Year Forward View – setting out actions to deliver care fit for the future. This plan should transform the way that care is delivered to ease pressure on hospitals by helping frail and older people live healthier, more independent lives. The next steps also outlines practical solutions on areas we know are extremely important to the public, namely, cancer, mental health and GP access.

This is because of the extent and nature of the change being called for, which is a major rethink of the way we deliver care across the country. It was an eye-opener at the time but, with everyone committing to new ways of thinking and solid partnership working, this dramatic change will ensure the NHS continues to deliver quality and timely care now and in the future.

Since 2015, the new care models programme has set out to link up services across primary and secondary care, and establish direct partnerships with social care, to enable quicker and higher quality access to care in the community and reduce pressures on busy GP and hospital services. The programme kicked this into action by selecting 50 vanguards from across the country. The successful applicants for the programme were picked based on their plans for their communities, outlined in redesigned care pathways that took in – but not limited to – general practice, hospitals, pharmacies, voluntary and community groups, social care and paramedics.

These new approaches have involved many different organisations and the NHS ambulance service is no exception. Like many others, it has recently redefined its role, moving away from being seen simply as a service that conveys patients to hospital, to a ‘central coordinating hub for provision of clinical advice and a mobile healthcare provider’, according to the publication of the Association of Ambulance Chief Executives, Leading the Way to Care.

Much of the focus of the new care models programme has been on reducing pressure on hospitals and redirecting care into the community, and I have been fascinated to hear about how paramedics have been working in partnership with our vanguards to really make a difference. Paramedics have an excellent range of skills that make them ideal candidates to substitute for GPs in certain cases. Given that a paramedic can carry out a patient assessment and triage and apply treatment, provide intravenous medicines and advanced life support, they are well-equipped to provide care and support to people in their homes.

In fact, this is exactly what is happening at North East Hampshire and Farnham vanguard (@NEHFCCG), which has had one paramedic employed in primary care since September 2016, who carries out home visits in place of GPs where appropriate.

At the Encompass (Whitstable, Faversham and Canterbury) (@encompassmcp) vanguard, a team of community paramedics undertake urgent home visits on behalf of GP practices. Since the scheme was rolled out, 4,500 patients have received home visits and, data from the vanguard shows, the transfers to A&E has reduced by 5.5% for the current year to date.

But probably the best known example – and it really is a fantastic bit of cross-working – is the ‘red bag’ scheme (or hospital transfer pathway, to give it its proper, but less snappy, name) at Sutton Homes of Care (@SuttonHoC) vanguard. This initiative was designed to improve care home residents’ journey through the healthcare system should they need to be admitted to hospital, and is the product of the London Ambulance Service working in partnership with NHS Sutton Clinical Commissioning Group, Epsom and St Helier University Hospitals NHS Trust, Sutton Community Services and care homes representatives.

The red bag is a physical item that contains standardised paperwork, medication and personal belongings, which stays with the care home resident during their journey from care home to hospital and back again. The bag means that everyone involved in the resident’s care has vital information to hand about the resident’s general health, such as any medication they are already taking.

The ambulance team play a vital role here in receiving the red bag from care home staff, checking the paperwork, and then passing it on to hospital staff while ensuring they know to keep the red bag with the patient at all times. When the patient returns to their care home, the ambulance staff make sure the red bag is passed back from hospital to care home, again with important paperwork checks.

This saves time during the transfer from care home to ambulance and from ambulance to A&E, as staff will have the information they require about the patient. It allows A&E staff to make more informed decisions about the patient, as they are aware that they are a care home resident; and it allows for speedier discharge, as hospital staff know that the patient is going back to a care home.

At Sutton Homes of Care, ambulance staff continue to play a key role: a paramedic lead is an appointed member of the vanguard steering group and plays an active part in task groups set up to design new interventions and innovations across the vanguard. Sutton Homes of Care has reported:

  • A reduction in the number of residents taken to hospital by ambulance, against a backdrop of increasing rates across London;
  • Patients admitted to hospital are staying an average four days less as a result of standardised paperwork and the red bag scheme;
  • Care home residents have improved satisfaction in the service received.

There’s a certain charm in the simplicity of the red bag scheme and it has proved so successful that at many other vanguards (and non-vanguards) are trialling it in their areas.

Hearing these wonderful stories is what I love about leading the new care models programme – they are  excellent examples of collaboration that are really making a difference. But they are, of course, just part of the wider story of this programme, where everyone is in it together – evolving and adapting their services to shape and deliver these exciting new ways of working.”

Samantha Jones (@SamanthaJNHS) is NHS England’s Director – New Models of Care.

Samantha was appointed as NHS England’s New Care Models Programme Director in January 2015 leading the implementation of new models of care as outlined in the NHS Five Year Forward View. 

She started her NHS career as a paediatric and general nurse and was a national management trainee. Having worked in a variety of operational management roles, and in the national clinical governance support team, she became the Chief Executive of Epsom and St Helier Hospitals NHS Trust. 

Following this, Samantha worked in the independent sector before she was appointed Chief Executive of West Hertfordshire Hospitals NHS Trust in February 2013. In 2014 she was awarded Health Service Journal Chief Executive of the Year and the trust’s “Onion” was highly commended in the patient safety award.

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