Specialist/Enhanced Paramedic
A specialist/enhanced paramedic is a registered paramedic who has either completed, or is currently undertaking, a postgraduate diploma (PGDip) relevant to their area of practice. They possess an enhanced knowledge base, advanced decision-making capabilities, and demonstrate a high level of competence and professional judgement.
The role of a specialist/enhanced paramedic spans all four quadrants of the paramedic career framework, with a particular focus on advanced development within a specific quadrant – namely clinical. Whereas an enhanced paramedic will remain generalist and have a broad uplift of knowledge to optimise their patient care, a specialist paramedic will have a particular focus, areas of specialism may include urgent care, critical care, end-of-life care, or mental health, although this list is not exhaustive, as new areas of specialism continue to emerge each year.
Case studies
Use the case studies below to learn more about the experiences of different individuals.
A person’s role may start to develop more formally into the other quadrants. Each person has a pie chart showing how much of the different quadrants is involved in their role.
Below is the colour code for each quadrant:
Education
Leadership & Management
Research & Development
Clinical Practice
Samuel Duncan
Trainee Advanced Clinical Practitioner and Specialist Refugee and Asylum Seeker Practitioner
20%
20%
20%
40%
Hannah Amondson
Specialist Care Practitioner
20%
20%
20%
40%
Samuel Duncan
Job title:Paramedic Trainee Advanced Clinical Practitioner - Specialist Refugee and Asylum Seeker Practitioner
Entry route: BSc (Hons)
What steps did you take in your professional journey to obtain your current position?
10 years ago, when I started my career journey, I did not expect to be a Paramedic Trainee Advanced Clinical Practitioner, and Specialist Refugee and Asylum Seeker Practitioner, working within a dedicated health inclusion service. A role that ensures high-quality care is accessible to all patient groups irrespective of geography and demographics.
I was fortunate to study the BSc. Paramedic Science degree at the University of East Anglia, a course that promoted advancing the profession and clinical practice. Through this course, I recognised my passion for public health and the importance of considering how diverse factors can increase vulnerability in health. Thankfully, lecturers supported me in recognising the value of paramedics in a breadth of roles outside the ambulance service, starting my interest in health inequalities. An interest further developed through discussions with colleagues and clinical encounters as a paramedic.
I left the ambulance service unsure where my career would take me and found myself working for NHS mental health liaison services during the COVID-19 pandemic. A role which was both extremely rewarding and equally challenging given the restrictions enforced on individuals by a global pandemic. The diverse range of individuals supported through this role during the pandemic emphasised the diverse factors impacting upon health and the need to accurately identify circumstances leading to an individual's presentation, and consider a range of interventions to provide effective support. These experiences led me to my current role within a dedicated health inclusion service, particularly in a role delivering health outreach services to asylum seekers within the local community. A role that incorporates clinical practice, leadership, education and research into daily practice to improve clinical practice and patient experience.
Alongside this full-time work, I am vice-chair of the College of Paramedics Public Health Special Interest a Group which was established to build knowledge surrounding public health within the profession, and knowledge of the roles the paramedic profession plays in supporting public health amongst organisations and leaders nationally. This opportunity has allowed me to advocate for innovative approaches to improve the awareness of health inequalities, developing the practice of the paramedic profession whilst ensuring better health promotion and prevention for patients within public health strategies.
What does your typical working week/day look like?
I am very passionate about my work and I definitely work well outside office hours but my role offers flexibility that I would not have in the NHS and I am grateful for that. I work mainly from the university and at times from home. Travel is mainly for conferences and presenting my research. My work week varies greatly because I have 3 roles: Associate Professor/Deputy Head of Department and Faculty Simulation Lead. This means there are times where my research takes precedent due to bidding deadlines as Associate Professor. I also mentor other staff members to help increase their research profile and work on primary research and grant writing. The same can be said for my deputy head role, there are times in the academic calendar where we have line management and leadership deadlines to meet as well as teaching heavy times and marking. As the simulation role represents the Faculty I try to create space for at least 10-15 hours a week for this. This is a vocation for me and trying to make an impact in this profession is a privilege. Balancing work and life is important and I confess an area I can work on improving!
What is your favourite thing about your role?
What really matters most to me is helping my clinical paramedic colleagues manage mental health patients in a way that serves all involved in a better way. It started from my feelings in clinical practice and has continued to develop from there, doing my PhD on this subject area and then writing a book on it has been hugely rewarding on a personal and professional level. It is also a privilege to teach and help develop the future paramedic workforce. It is a gift to be able to share and exchange knowledge and to help our profession grow and develop.
What about your role is most challenging?
It would be a tremendous honour to become a Professor in Paramedic Science one day. It is certainly something I aspire to in the long term. In the short term, my focus remains on creating research and educational opportunities around managing mental health.
What advice would you give to others aspiring to reach your position?
Never say no to an opportunity even if it scares you. I never dreamed of doing a PhD, never mind completing one and becoming actively involved in research. This is actually my second career, I used to be a journalist and editor. Don't let anyone dissuade you of what you truly feel is your passion. I moved countries to fulfill my potential and looking back, despite some really tough times and some even tougher career decisions...I have no regrets. I am exactly where I should be.
Hannah Amondson
Job title: Specialist Care Practitioner
Entry route: Dip HE
What steps did you take in your professional journey to obtain your current position?
I graduated from the Uni of Herts in 2004 as one of the first graduate paramedics. Worked frontline in London and then transferred to clinical advise doing telephone triage, finding alternative care pathways for patients that did not require an emergency ambulance. Spending some time on a green car, assessing and referring patients to alternative forms of care in the community such as falls teams, GP's etc.
I moved to East of England, working a rapid response car doing a similar role combined with emergency care. I then moved back into telephone when my health deteriorated until I retired in 2015. After a period of recovery and a change in personal circumstances I completed a return to practice course with the Uni of Coventry and secured a practice placement with a GP surgery. I went on to gain my registration back in 2023 and started to help with the e-consults and telephone triage while completing a part time post grad certificate course in first contact practice with the Uni of Cumbria. I was offered a position that worked round my disability, pension and benefits by the surgery I did my placement with. My mentor was an advanced paramedic practitioner who has been a trainer in the ambulance service for many years before moving into primary care.
What does your typical working week/day look like?
I review the e-consults that come in and task them for appointments with the most appropriate clinicians and set a time frame for them to be seen within. Sometimes directing them to self care of pharmacy first services. Any that look urgent I phone to assess and redirect to A and E, ambulance service or book same day appt with GP. I tend to see minor illness/infection such as ENT, chest and female urine infections in all age group. Some times a minor ailment in an older person will turn out to need an urgent referral for possible cancer.
What is your favourite thing about your role?
I see a wide variety of cases, working within a small multidisciplinary team. I am always learning new things and new ways of working from different members of the team. I am given quite a bit of autonomy but there is always support and someone to ask for a second opinion. It challenges my problem solving skills which I love.
What about your role is most challenging?
Seeing patients at first presentation and working out if tests, treatment or even time are the best approach is challenging. I am used to triaging and working to protocols and referring on. I now have to decided what next and when test are appropriate and at what stage. Although there are NICE guideline co-morbidities, time, patient preference and other factors cloud the decision making process and what initially looks like a straightforward decision becomes complex. Time management is another key element within primary care I had not appreciated before. Trying to keep to the allocated appointment times when patients come in with complex medical histories or find it difficult to articulate the problem.
What continuing professional development are you embarking on, or thinking about next?
I am considering doing my prescribing course. However being new to primary care and only just having qualified as a first contact practitioner, working only 1 day a week in practice I feel I need some more experience first before committing to the next stage.
What advice would you give to others aspiring to reach your position?
If you feel that you want a change or want to work more independently or even want to move away from shift work then primary care is a more flexible career option. The skills of a paramedic lend themselves well to primary care- seeing and treating minor illness and injury and ruling out acute illness that needs hospital attention. Many of my colleagues work for primary care network and do home visits within care homes and housebound patients. However due to my previous experience in triage and disability I am based in the surgery. However as my ACP mentor keeps telling me you can make the job your own in primary care, you can pick an area to specialize in . For instance he has chosen dermatology and learning disabilities and does all the mole checks, rashes and learning disability health checks. My area seems to be triage and reasonable adjustments for people with disabilities within the surgery having completed an innovation project on it at Uni and shared my findings with the intermediate care board.
Spending some time researching different areas of the profession and going with your interests would be my advise. Many places are happy to have people come and observe in different settings. Kent and Medway ICB are doing a series of webinars on different roles and a couple of my ACP/ANP collogues have shared how they got to where they are and what they do on a day to day basis.
There are some video case studies on what FCP/ACP paramedics do in primary care on their website too.
https://kmpctraininghub.nhs.uk/primary-care-roles/first-contact-practitioners
https://kmpctraininghub.nhs.uk/primary-care-roles/advanced-clinical-practitioner