• London trust pledges to boost senior paramedic numbers to take heat off A&Es
  • Ambulance provider aims to cut rates of conveyance to A&E by 10 percentage points
  • Ambitious five-year plan also predicated on integration with community teams

London Ambulance Service Trust has pledged to treat more patients at the scene to cut the capital’s high conveyance rates under ambitious plans, which include a significant increase in senior paramedics, its medical director told HSJ.

The trust, removed from special measures and rated good by the Care Quality Commission last month, plans to more than quadruple its advanced paramedic practitioner for urgent care workforce, from 15 to “up to 75”, Fenella Wrigley said.

The trust aims to cut conveyance rates to emergency departments from 63 per cent to “nearer to 50 per cent” within five years by treating lower acuity patients at the scene or joining them up with community-led services under its 2018-19 to 2022-23 plan.

The trust piloted the model in Croydon. APPs treated 63 per cent of patients without conveyance to hospital, compared to a London average of 36.6 per cent.

Dr Wrigley said: “Our advanced paramedic practitioners not only provide care, but also leadership and support to other crews.”

The advanced paramedics, supported by new assessment teams who provide further clinical advice over the phone, will largely be used to ensure more lower acuity cases and category three and category four call-outs, are treated on scene.

Dr Wrigley said that “over 60 per cent [of the lower acuity categories] do not require going to hospital if appropriate alternatives exist”. “That allows ambulances to be free for the category one and two patients [life threatening cases],” she added.

The trust said the new measures could reduce emergency admissions by 95,000 “saving London’s health system between £9.5m and £12.8m per annum”.

Paramedics on scene will also be supported by a new “virtual clinical assessment service” being established by London’s sustainability and transformation partnerships, which will provide further advice.

New patient pathways to ensure a more joined up approach between the ambulance service, local community and primary teams and GPs, and for paramedics to have access to patient records will also be required under the plans.

London has historically struggled with high conveyance rates. The capital has many hospitals within a relatively short journey time and conveyance was often seen as an “easier option”. This would not necessarily be the case in a rural area where the nearest hospital is 40 minutes away, Dr Wrigley said.

London Ambulance Service Trust also has 33 APPs who focus on critical care - rather than the category three and four patients the new APPs would concentrate on. Trust chiefs hope offering paramedics the opportunity to boost their skills and income will prove an incentive to pursue careers in a sector with significant recruitment and retention challenges.

But filling the vacancies will likely prove challenging. A survey by The Observer published in March found seven out of the English NHS’s 10 ambulance trusts were struggling to recruit, and London had the highest number of unfilled posts.

The Association of Ambulance Chief Executives supported the London plan. A spokesman said: “We fully support any ambulance service initiative that attempts to treat patients more appropriately without having to take them to hospital.

“Indeed most ambulance trusts are using technology and additional training, skills and equipment to reduce conveyance rates with the aim of alleviating pressures on emergency departments and potentially speeding up treatment for patients.”