Fitness to practise defence Barrister, Stephen McCaffrey, looks at the problem of Paramedics self-referring to the HCPC.

Paramedics are disproportionately represented in HCPC fitness to practise investigations and hearings.  This stems from too many self-referrals, but what should paramedics know before self-referring?

How big is the problem?

Registered professionals are required to refer themselves to the regulator if they believe their behaviour presents a risk of regulatory action being taken against them.

The proportion of paramedics who self-refer is high compared to other professions. For example, between 2013 and 2016, self-referrals made up 50% of all paramedic cases, compared with an average of 6% from other health professions.

The 2019 HCPC fitness to practise report indicated that paramedic self-referrals accounted for 127 out of 302 fitness to practise referrals.  This represented more than 12% of the entire HCPC fitness to practise case load.

In 2018–19, 164 applications were made for interim orders, accounting for almost 7 per cent of the cases received. This is consistent with the previous year. The majority (71%) of those applications were granted. Paramedics had the second-highest number of applications.

Common issues and allegations

Research indicated that the most common clinical complaints relating to paramedics and that were not closed during the HCPC triage stage related to:

  • Alleged delayed answering Red 1 call
  • Alleged dropped patient off a trolley in emergency department
  • Alleged failure to conduct full assessment on elderly patient
  • Poor record keeping
  • Failure to provide adequate care
  • Failure to respond to an emergency call
  • Conduct in a clinical setting

A large number of these are self-referrals relating to one off incidents.

Why is there a problem?

Research has shown that the reasons are complex but can broadly be defined as:

  • The practice of professions in general has become more complex, meaning a growing proportion of a paramedic’s day-to-day work involves conflict resolution, negotiation, and interpersonal risk management rather than technical activities such as intubation and resuscitation.
  • The rapidly changing scope and nature of paramedic practice may also give rise to misapprehension about when to inform the regulator of incidents which take place at work and outside of work.
  • Ambulance services do not investigate complaints but refers paramedics straight to the HCPC.
  • Paramedics self-refer to HCPC after an incident in order to demonstrate that they were acting responsibly.
  • Paramedics wish to ensure a ‘fair’ hearing and do not necessarily have confidence in their employers to deal appropriately with the incident.
  • A variation in the guidance on self-referrals given by employers, with some instructing paramedics to self-refer all incidents.

HCPC self-referral – standard 9.5

Under standard 9.5 of the HCPC’s Standards of conduct, performance and ethics, paramedics as HCPC registrants, are required to tell the HCPC if:

  • they accepted a caution from the police or have been charged with, or found guilty of, a criminal offence;
  • another organisation responsible for regulating a health or social-care profession has taken action or made a finding against them; or
  • they have had any restriction placed on their practice, or been suspended or dismissed by an employer, because of concerns about their conduct or competence.

Of most relevance is the third point above.  The HCPC guidance goes on to say that:

“Restrictions placed on your practice means that your employer does not allow you to practise in your usual role with your usual responsibilities or freedoms, because of concerns about your conduct or competence.”

This might include:

  • Being removed from your usual duties, such as on-call shifts;
  • Being prohibited from delivering your usual care or treatment without direct supervision, such as administering medicines;
  • Being prohibited from making your usual decisions without approval from a colleague, such as discharging a service user.

Outcomes for paramedics self-referring

Broadly speaking, around 20% to 25% of paramedics self-referring to the HCPC end up before a fitness to practise committee.  Roughly the same proportion of self-referrals are referred to the HCPC’s Investigating Committee, that meet to consider all evidence put before them and decide whether there is a case to answer.

Approach with caution and seek advice

Is there value in legal representation for paramedics facing HCPC fitness to practise investigation and hearings?  Let us look at the facts and evidence:

  • Paramedics have some of the highest number of cases that end up before a HCPC fitness to practise hearing.
  • The HCPC granted over 70% of Interim Orders applications, with paramedics representing some of the highest Interim Order cases.
  • Although paramedics had some of the highest number of cases that went to a hearing, 50% of paramedics represented themselves or had no representation.
  • 68% of cased before a HCPC fitness to practise committee, involving paramedics, resulted in some form of sanction (i.e. suspension, striking off, caution or conditions of practice).
  • The HCPC data shows that, in the majority of cases, registrants with representation have better outcomes before a HCPC fitness to practise committee.

It is clear that paramedics are over-represented in HCPC fitness to practise proceedings due to a very high proportion of self-referrals.  These self-referrals are, in many cases, unnecessary and unjustified.

There are numerous opportunities for paramedics to intervene in the process, for example to present evidence and/or responses to HCPC correspondence.  These are opportunities because with the correct advice and guidance, a fitness to practise investigation could be closed before it reaches a full hearing.

There is clear evidence as to the value of legal representation and advice. Paramedics should seek advice at the earliest possible opportunity to understand the implications and necessity of a self-referral and take advice on the best approach to take.

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