First contact paramedics are autonomous, diagnostic clinicians with experience in handling undifferentiated and unpredictable cases; conducting an array of clinical assessment, diagnostic, and treatment activities; and directing and signposting care. They are at the top of their clinical scope of practice at Agenda for Change Band 7 NHSE Roadmaps to Practice.

As generalists, they can effectively use the medical / biopsychosocial model to assess, examine, treat, and manage patients of all ages, with a variety of undifferentiated and chronic conditions. Their work can involve triaging patients, carrying out telephone and face-to-face consultations, and conducting home visits. They refer patients to GPs for the management of presentations and pharmacology outside their scope of practice.

For more information, please read NHSE Roadmaps to Practice and the College of Paramedics’ Employers’ Guide: Paramedics in Primary and Urgent Care.

GPs face a constant and increasing demand for their time. First Contact Paramedics can help to alleviate this by addressing a wide range of undifferentiated presentations to urgent and primary care (including frailty, long-term conditions, and mental health crises). In so doing, they not only enable GPs to turn their attention to more complicated presentations when needed, but paramedics also ensure that patients can receive equitable treatment from a MDT workforce that isn’t so unduly strained. Patients are less likely to need to go to the hospital, as paramedics are well-equipped to see, treat, and / or refer as appropriate by themselves performing home visits.

Please see the Paramedic Specialist Core Capabilities Framework below for more information.

First Contact Paramedics’ scope of practice is outlined in NHSE Roadmaps to Practice for First Contact and Advanced Paramedics. This document offers a clear educational pathway from undergraduate to Advanced Practice for Paramedics seeking a career in primary care, outlining the skills and attributes required to become a First Contact Paramedic or Advanced Paramedic, in addition to establishing the supervision and governance needed to support them.

In asserting the capabilities of First Contact and Advanced Paramedics, this document assists employers and workforce planners in understanding what this role can bring to the table in a multi-professional team, and thereby support the delivery of the best patient care.

Here is an example of what an First Contact Paramedic can see, this may change dependent on the individual paramedics and previous experience and training.

First Contact Paramedic Scope of Practice.

First Contact Paramedics can be recruited by PCNs through the Additional Roles Reimbursement Scheme (ARRS). This scheme provides funding for additional roles, enabling the creation of bespoke multidisciplinary teams. All PCNs are eligible for reimbursement funds, with the amount available dependent on their weighted population share.

Through ARRS, Paramedics can be employed by PCNs and reimbursed at 100% of defined salary, plus defined costs. More information on this can be found in NHS Confederation’s guide.

Further information can be found below.

• DES contract.
• Additional Roles at a Quick Reference Summary.
• CQC Mythbuster.

The College of Paramedics (CoP) states that all Paramedics should have a BSc (Hons) to be registered with the Health and Care Professions Council (HCPC). This qualification is acquired over 3 to 5 years of study. Paramedics working in Advanced Practice should be educated to the level of a Master’s degree, however.

NHSE notes that Paramedics must typically have 3-5 years post preceptorship experience before starting primary care training to become a First Contact Practitioner.

Further information can be found via these toolkits.

• Paramedics in Primary Care Toolkit
• BNSSG Training Hub Paramedic Toolkit

Paramedics can train to be a First contact practitioner via 2 routes:

University taught route – there are several fully funded courses available for Paramedics to attend:

Paramedics can also undertake the portfolio route, this route is aimed at individuals with previous post graduate training and / or primary care experience. See the Paramedic Toolkit for further information.

Paramedics wishing to become NHSE Accredited Advanced Practitioners see the Advanced Practice page for more information.

Paramedics and Primary Care Teams for General Practitioners

NHSE Paramedics in General Practice

Job Descriptions tACP or FCP Paramedic

Job Descriptions PCN Paramedic

Example of interview questions

Understanding the Paramedic CV

Paramedic induction

Supervision under ARRS

The Network Contract DES specifies the minimum supervision requirements for staff hired through the ARRS. The table below outlines the recommended minimum frequency for supervision meetings and identifies who can provide this supervision. Each clinical supervision session should last at least one hour.

These recommendations are based on the Network Contract DES requirements, professional regulatory standards, and expert guidance.

More information can be found in NHS England’s’ supervision guidance for primary care network multidisciplinary teams.

Paramedics acting as supervisors

Paramedics established in primary care may provide clinical supervision for junior staff members across different professions. Paramedics working in a supervisor role should have undertaken the necessary training to be able to do so, depending on the requirements set out in the relevant national workforce plan (England, Northern Ireland, Scotland and Wales).

Supervision guide for FCPs.

FCP Portfolios

• Fourteen Fish
• Agilio (Clarity)

Free Portfolios

• Paramedic FCP Excel Portfolio
• Paramedic FCP Excel Portfolio Guide

FCP Portfolio Blank Templates

• Audio COT
• Case-Based Discussion FCP to Advanced Practice
• Clinical Supervisor’s Report
• Consultation Observation Tool – FCP to Advanced Practice
• FCP Roadmap
• FCP Verification Form
• Level 7 Module Performa
• Multi source feedback form
• Patient Satisfaction Questionnaire
• Personal Development Plan
• Patient survey questionaire and multi source feedback form via accuRx guide
• Reflection Example
• Tutorial Evaluation
• Tutorial Record

A Non-Medical Referrer (NMR) is a nurse, allied health professional or clinical pharmacist who has extended their role to include referral to radiology to improve the delivery of care to patients.

The Ionising Radiation (Medical Exposure) Regulations 2017 (and subsequent amendments) {IR(ME)R17} defines an NMR as being a member of a profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002(a).

For more information regarding IR(ME)R please see:  The Ionising Radiation (Medical Exposure) Regulations 2017

IR(MR)R training dates

What training is required?

All NMRs should receive IR(ME)R training which is updated every 3 years. The training should cover the principles of radiation protection, legislation, benefits and risks of the examinations being referred for including an understanding of the dose.

Training Dates and FAQs

For more information regarding Imaging requesting for Non-Medical referrers please see the Avon Local Committee website Radiological Imaging for non-medical referrers – Avon LMC.

Further advice or information about imaging for Non-Medical Referrers (NMR)

Please use the dedicated email addresses below:

• NBT: nmr@nbt.nhs.uk
• UHBW: RadiationProtectionTraining@UHBW.nhs.uk