As well as showcasing new and emerging roles within the health sector (including nursing assistants and mental health coaches), the Health Workforce Australia Conference 2013 (HWA 2013) featured innovative projects focused on broadening the scope of existing professions.
Extending the scope of practice of individual health professions can help meet the growing demand for healthcare in many areas of Australia by increasing the flexibility and productivity of the health workforce and supporting improved recruitment and retention. If implemented with strong consumer involvement it can also help provide care that is centred around consumer needs and priorities.
One promising project being run by HWA focusses on extended care paramedics (ECPs). ECPs are experienced paramedics with advanced training and skills in patient assessment, delivery of quality care and coordination of appropriate referral pathways. ECPs generally treat patients in collaboration with other health professionals and in their homes, including aged and community care facilities. This reduces the need for both emergency department presentations and hospitalisations, leading to increased patient satisfaction with care and reduced overall health care costs.
HWA has funded five implementation sites to test an existing ECP model to look at how it can be adapted to better meet local need and conditions. The model is based on the SA ambulance model that has operated since 2008. This model was chosen after extensive examination of national and international models of extended scope paramedics and similar. These included examples in the UK, Canada, US and Qatar.
The model has been adapted to local needs at each of the implementation sites in South Australia, the ACT, Tasmania and the Northern Territory. The sites began operation in January 2013 and are due to be completed by June 2014.
The aims of the ECP project are to:
- Reduce disruption to patients, their carers and families by providing care to patients where they live, when appropriate.
- Reduce the cost to the health system associated with emergency department presentations and patient transfers between medical facilities.
- Increase career pathways and retention strategies for paramedic professionals through the provision of expanded roles.
The two-year project has provided grants totalling over $3.5 million to the five implementation sites to develop and put in place ECP models within local communities. The tasks undertaken by extended care paramedics complement the primary healthcare delivered by general practitioners and other health professionals in the community.
A national evaluation of the ECP model will be undertaken to determine the critical success factors required to ensure sustainability of the model at each site and support adoption of the role nationally.
Progress from the project was reported in a workshop Extending the scope in paramedics in providing care at HWA 2013. Speaking at the workshop were Shaun White, Matthew Smith, Marty Owen (below), Erin Maczkowiack and Bradley Sanderson who are all involved in the project. 
At the workshop Shaun White began by asking the question “What if we had a system that wasn’t built on the assumption that all patients go to hospital?” He described the project as “Taking the right care, to the right patient, at the right time.” He said that the majority of patients don’t want to go to hospital and that this model allows appropriate and safe care to be provided where the patient feels most comfortable.
White described how the ECP model combats paramedics’ frustration at not being able to deliver the care that the patient needs by giving them the training and support to maximise the effectiveness of the services they provide. The ECP model is “Enabling health professionals to work at the top of their license and ability” he said.
The presenters made clear that ECP is not about taking over or replacing existing roles but working in collaboration with other providers to meet the needs of the patient. This is achieved by having a clinical governance framework; medical mentors; clinical coordination; clinical guidelines and training and continuing professional development.
While the presenters supported the main goal of the project – to move patients from pre hospital care to out of hospital care – they also noted that they were addressing a need for health care among some groups who do not typically access other services. For example, they said that homeless people could benefit from ECPs as they are frequent users of ambulance and paramedic services but often don’t engage with wider medical services, such as general practice.
Paramedic Erin Maczkowiack (below) described how she was called to an aged care facility one night where an elderly female resident had fallen. The patient’s family had arrived and were concerned about her going to hospital due to previous negative experiences with hospital care. The woman herself was also agitated about the potential of having to go to hospital. Erin worked with the aged care nurse based at the facility and also contacted her GP to provide appropriate care and she did not have to be taken to hospital. Both the woman and her family were delighted with the outcome and the care provided by Erin, in conjunction with the nurse and GPs.
Early results from the evaluation of the project are positive. The model is helping to divert patients from hospital to primary care and patients are receiving the treatment they need from the right practitioner, in the right place at the right time.
There has also been very positive feedback from clients. “We had two options in the past – leave them at home, or take them to the ED. This is not what the patient needs. They need primary care,” according to paramedic Matt Smith (left). 
Smith, an ECP responsible for implementing the project in the ACT, discussed how the model could be sustained in the future. “Paramedics historically have not recognised that they are part of the primary care system,” he said, but the ECP model relies on paramedics working closely with other primary care providers. He described how each of the five sites has made slight variations to the ECP model to suit their local needs. For example, in one site the ECPs are working as a hybrid of the emergency paramedic team. However, in Canberra there is a standalone ECP model. He said that the main challenge now was to identify the most sustainable model for the future.
This article is part of Croakey’s coverage of HWA 2013 – the rest of the articles can be found here. Thanks to HWA staff for notetaking, photography and support in writing these stories.
