A national programme had the ambitious intent to reduce A&E attendance by 1 million. They had already identified Emergency Care Practitioners (ECP), which is an experienced paramedic/nurse/AHP who receives additional training so that they can diagnose, treat, or refer directly to an appropriate service avoiding A&E.

ECPs are expensive to train (£40,000 each) so the program needed to identify who makes the saving, and how do they know that they've made it. The evaluation and economic modelling, involving extensive stakeholder engagement, showed an ROI of 2 to 3 years through: a single responder in a car instead of two crew in an ambulance to appropriate calls (Ambulance Review 2005: Taking Healthcare To The Patient); reduced A&E attendance (offset against the increased cost of use of other services); and use of additional skills of the ECP in other environments eg Out of Hours. PCTs were able to benefit from the money saved, so PCTs agreed to fund 800 places for training with ambulance trusts (£32 million).

Other outcomes: –

• a cultural shift towards measuring outcomes (for patients, for the service) not just activity
• working with the rest of health economy
• career progression for ambulance men whose previous choices were management or training
• patients treated at home instead of "scoop and run"

Benefits Management - how to deliver ECPs

ECPs are an excellent example of a really successful new form of advanced front-line clinician. They were developed from the ground up, harmonised across the country by sharing benefits and picking the best from each site. I was initially involved with the 17 pilot sites the national team encouraged local innovation, my work was twofold:

1. to coach the sites so that they reported what they had achieved, and just as importantly the lessons learnt, so that others could steal with pride and converge on a single model
2. to justify investment by PCTs and Ambulance Trusts in 800 of these advanced practitioners.

ECPs continue to remain a distinct and homogeneous new profession, one of very few widely adopted new professionals in 15 years, and I continue to serve on the national panel steering the profession to registration.

Some of the key publications to emerge are listed in the child pages to this page (below)