Community Specialist Paramedic, Mark Wenman MondayThe day starts with a meeting with the Triage Development and Evaluation Officer to discuss an idea I have about assisting care homes to use the ambulance service more appropriately. A couple of hours later, the first draft of a triage tool is written and ready for further evaluation when approved, care homes and nursing homes will have guidance in which services are best suited for their residents. I’m back to Skelmersdale for a talk at a local community centre as I’ve been asked to talk to the group about the ambulance service and future community engagement in the centre. Then it’s over to the local walk-in centre to discuss a six month pilot for a potential minor injuries pathway which, if utilised by crews, will support ongoing discussions to increase acceptance criteria enabling patients to be treated closer to home whilst crews will be available to respond to life threatening emergencies. TuesdayWith my vehicle and equipment check completed, I’m on way to attend a local meeting regarding community care plans when I receive a request to respond to a local Red 2 incident - a patient who has fallen with minor skin tears. Following a full examination, the patient is referred to both local Acute Visiting Service (AVS), Community Emergency Response Team for further treatment and Carlisle as a falls referral. I’m a little bit longer than normal on scene but it should ensure that the patient receives appropriate care at home. I arrived at my meeting, slightly late but my apology is accepted and we discuss the importance of community care plans to patients, North West Ambulance Service (NWAS) crews and how we endorse the creation of plans by GPs. Now onto second meeting of the day to discuss engagement with the Clinical Commissioning Group (CCG) in relation to a new NHS scheme which relates to the development, testing and piloting of a set of linked interventions to improve the health of the poorest, in some of the most deprived areas of the North of England. After the meeting, I’m once again free to respond which provides me with the opportunity to catch up and speak to crews. WednesdayBusy start to the day today - part of my CSP role is to provide additional responding resource in the community, so spend a few hours responding to red calls to assist in taking some of the strain off the local area crews. Once activity has eased, I’m off into the local AVS scheme provider – OWLS, for some stakeholder engagement but also to get the local AVS figures for NWAS referrals. Really great to see that referrals rates are up and improving month on month by crews in the area, more importantly that all referrals are treated at home, with the GPs giving credit to the crews for referring the right patients. Next, I attended the Frail and Elderly Proactive group; a multidisciplinary team who are discussing issues around the local elderly population, residential homes and associated issues. My triage tool for nursing homes is discussed at length, along with the implementation of telemedicine. This group is a great group to work with and be part of, as it offers networking and collaborative working, with individuals who have similar interests and drive to develop pathways and schemes for the local community. I manage to have a quick catch up with the local CCG lead, before I finish for the day. ThursdayI’m over in Ormskirk first thing to meet with the NWAS governor, who is a local councillor, ex-mayor and lead for the local defibrillator campaign. A lady with many ‘hats’ who is also extremely nice, compassionate and keen to work together on a range of issues - she’s also very persuasive and I agree to a press photo with new AED and attendance at numerous AED/Heart Start courses in the area. From here, I go over to the local CCG member’s forum, where I’m introduced to some of the key stakeholders in the area but unfortunately this is cut short by a RED 1 response close by. I arrive on scene, quickly backed up by a local crew. The patient is treated and I handover to the crew for transportation to hospital and return to the CCG members forum; GPs are very engaging and pleased with not only having a Community Paramedic in the area, but also a representative from NWAS. Once back on station, I start to produce a plan covering some of the ideas that I would like to implement in the area, which will need to be submitted for approval. I’m off Friday and Saturday this week, but back working on Sunday with my host provider, OWLS. SundayOWLS are the local AVS and out of Hours GP scheme provider. I’m working on an action plan of clinical scope with my nominated GP mentor. At the moment, I’m taking a lead on consultations and either being supervised by my mentor or presenting the case to him prior to treatment or discharge. I’m straight onto the phones for some telephone triage, providing advice to patients or setting appointments for patients to attend the practice further examination. Patients who attend are seen and treated and patients requiring prescriptions are presented to the GP with a suggested medication requirement. Reflection and conversation takes place after most consultations to provide me with ‘live’ feedback, enabling me to discuss areas of uncertainty, whilst I’m learning lots about primary care and treatment. Paramedics in the practice are completely new, so there are a few areas and plans to discuss in future board meetings, but the possibilities and benefits are very positive.