Scope of Practice

Author:	Jono Erodotou
Responsibility:	All Staff
Effective Date:	01 June 2024
Review Date:	30th May 2025
Approved By:
Version Number:	01

Amendment / Review History #

Date	Author	Comments

Statement of Aims and Objectives

K4 Medical Services is committed to providing clinical care to the highest standard.

The company strives to meet changing patient needs by ensuring staff have the skills, knowledge and equipment in order to confidently care for our patients. The purpose of this policy is to provide clear guidance for all grades of staff of the scope and breadth of their practice and professional development.

The main principles underpinning the document are:

– To Provide instruction for staff to ensure they practice within clear boundaries
– To provide a framework which demonstrates that our company provides staff with the appropriate authority, supervision and training to meet the needs of our patients
– To define and / or reiterate the standards of clinical care required by K4 Medical Services / or regulatory / statutory bodies (i.e. Health & Care Professions Council, Medicines and Healthcare Products Regulatory Agency, Care Quality Commission).

This policy is intended to provide clear instruction for staff to follow in the course of their clinical care and will serve as the primary source of information relating to practice against which quality of care is upheld.

While scope of practice is individual to each member of staff, this document sets the company level of expectation in relation to what that scope of practice must include.

This document contributes to the maintenance of the standards we set ourselves and those that are required contractually or from national performance standards.

This document will define clearly those standards for staff and minimise clinical error by ensuring staff work within their scope and competency, and to required quality standards. The policy outlines the importance of promoting a learning, and how the standards related to scope of practice can be observed in order to uphold patient safety and quality of care.

Principles #

Staff must not exceed their scope of practice, but also must not fall below the range of skills and interventions set within each clinical practice area.

This document is not intended to be read and followed in isolation. Please refer to all the documents listed in associated documentation and references sections. This is particularly important when defining authority to refer or discharge patients.

It is the responsibility of each member of staff to raise with their line manager any perceived deficiencies or lack of contemporary experience in any practice area to ensure that the scope of practice is maintained. Where relevant, this links to professional requirements for continuous professional development.

Staff are required to provide care at an acceptable standard and this policy describes those core standards and the need for staff to practice in line with these requirements.

The company reserves the right to monitor and performance-manage staff in order to maintain their scope of practice and clinical standards.

The management of risk and evidencing of a governance-led approach to how the company plans and delivers care is vital, and the Trust is committed to ensuring that this is always paramount.

Maintenance of skills and standards described in this policy. #

The company has a robust system for appraising staff performance at all levels and functions within the organisation. The annual appraisal is a yearly plan developed between the member of staff and the line manager. The action plan reflects learning and development needs for the year ahead and provides a platform to address concerns over competence and confidence.

Staff are required to understand the standards of clinical care required as either terms of their continued employment and/or prescribed through a professional regulator.

Failure to work to the required scope of practice or whose clinical standards are below the minimum level. #

Clinicians who fail to work to the required scope of practice or clinical standard fall into one of three categories:

Inability due to lack of training and education (including update training to maintain competency). In this case the company must ensure that the individual receives the relevant training, education and support to enable them to work to the required level.

Unwilling to despite either receiving or being offered the required education and training.

Have the knowingly or unknowingly carried out procedures, actions or processes that are outside the scope of practice.

Cases may also be dealt with using the disciplinary procedure and/or capability procedure.

Each case will be independently reviewed; however staff should be aware that operating below or beyond their scope of practice could result in action under the capability procedure and/or disciplinary procedure and referral to a professional body (Health and Care Professions Council, Nursing and Midwifery Council or General Medical Council).

Procedures carried out outside scope of practice may be considered as assault, whether consent has been obtained or not, and the company may report incidents to the Police.

Amending the scope of practice #

The Scope of practice and clinical standards for ach grade (see appendices) can only be amended following approval be the Director Team. The purpose of these appendices is to set scope of practice and required level of clinical standards expected of clinical staff at all levels throughout the Trust, consistent with regulatory, professional or commissioned standards.

The company clinicians must follow clinical guidelines issued. These will usually follow JRCALC, although the company may elect to use other evidence bases for practice, or authorise practice as part of appropriately authorised research.

The Director Team is authorised to approve the addition, removal and amendment of the appendices of this document which relate to individual clinical grades. This will allow more rapid updating of the document.

Guidling Principles #

The specific skills and drugs for each grade of clinician can be found in the appendices. However, there are guiding principles and standards of proficiency that relate to all clinicians employed by or working on behalf of the Trust. These standards of proficiency are similar to those expected of paramedics by the HCPC and can be found in the HCPC standards of proficiency document. The following principles relate to the grade at which the individual clinician is working and draws heavily from the HCPC guidelines.

Clinical Accountability #

Registered clinicians must work to their professional code and standards published by their regulators (Health and Care Professions Council, Nursing and Midwifery Council, General Medical Council).

All company clinicians must: #

Practice within the legal and ethical boundaries of their work role.

Practice in a non-discriminatory and culturally sensitive manner.

Maintain confidentiality

Obtain consent and/or act in the patient’s best interest.

Exercise a duty of care.

Know the limits of their practice and knowledge and know when to seek advice and guidance from senior clinicians

Maintain their level of knowledge and their fitness to practice.

Undertake career-long self-directed learning using reflection to improve their practice.

Undertake development in order to maintain skills and knowledge in line with developments and changes in the role.

Inter-Disciplinary #

Know the personal scope of their practice and be able to make referrals to senior clinicians where appropriate.

Be able to work, where appropriate, in partnership with other clinicians and professionals, patients and their relatives and careers.

Work effectively as part of multi-disciplinary team and in partnership with other professionals.

Understand the need for effective communication throughout the care of the patient. This may be with client or user support staff, with patients, clients and users, and with their relatives and careers.

Identification and assessment of health and social care needs: #

All company clinicians must, within their scope of practice
– Be able to gather appropriate information.
– Be able to use appropriate assessment techniques.
– Be able to analyse and evaluate the information collected.

Knowledge, understanding and skills: #

Know the key concepts related to their level of clinical practice.

Understand the need to establish and maintain a safe practice environment.

Core principles of clinical standards #

Staff must practice applying the following principles.
– Assume patient autonomy and capacity. Always seek consent from patients where capacity or consciousness allows. Respect and follow all valid advanced directives of care.
– Do no harm to your patients. For instance, be minimally invasive, be thorough with checking medicines, and preserving dignity. Follow your scope of practice and do not exceed it.
– Allow no harm to come to your patient. Be your patients’ advocate to prevent drug errors or poor practice. Promote outcomes by ensuring your treatment for primary problems don’t lead to secondary illness (i.e. infection from poor aseptic technique or skin ulceration from inappropriate immobilisation on a spinal board).
– Staff must follow closely any standard of care from their professional regulator.

Definitions #

Scope of practice defines the boundary within which a clinician can operate. It describes the procedures, that are expected of each grade of clinician.

When referring to scope of practice, this document specifically means the scope of practice expected of clinicians working for the company.

Clinical Standards define the attributes required to deliver safe effective and high quality care. To illustrate the difference between scope of practice and clinical standards, intravenous cannulation is in the paramedic scope of practice but must be carried to a high level of clinical standard, including for example, obtaining consent, applying aseptic technique, communication and documentation.

Medicines Formulary Appendix H of this document lists the medicines authorised for possession and use by the company clinicians.

Responsibilities #

The Operations Manager has ultimate responsibility for Scope of Practice & Clinical Standards.

The Medical Director has executive responsibility for Scope of Practice and Clinical Standards.

The Clinical Manager and Operations Manager are responsible for overseeing the policy on a day to day basic and to oversee and ensure that staff work accordance with this policy.

All K4 Medical Services are responsible for observing the scope of practice and clinical standards commensurate to their clinical grade.

Within all areas of scope practice and clinical standards, all staff will adhere to the following areas:
– Safeguarding
– Mental Capacity
– Infection Control
– Medicine Management
– Information Governance and Caldicott Guardianship

Competence #

In order to practice in any of the roles described in the appendices, a clinician must have completed an approved programme of education and training which is reflected I their role title.

In addition, to work at the level of paramedic and above, clinicians must be registered professionals with the appropriate body for their role.

All Staff engaged in healthcare must undertake training as defined in the Scope Skills Training Framework (CSFT) from Skills for health, and all certifications must be renewed before they expire, including:
– Conflict Resolution
– Equality, Diversity and Human Rights
– Fire Safety
– Health, Safety and Welfare
– Infection Prevention and Control
– Information Governance and Data Security
– Moving and Handling
– Preventing Radicalisation
– Resuscitation
– Safeguarding Adults
– Safeguarding Children

Monitoring #

This policy will be monitored by the management team.
– This may include reports received via Patient Advice and Liaison Service (PALS), incident reports or verbal reports from staff.

Any non-compliance or deviation from this policy that results in an adverse outcome for a patient will be dealt with in accordance with our policies.

Audit and Review #

The policy document will be reviewed every three years; or earlier if required due to change in local/national guidance and/or policy; or as a result of an incident that requires a change in practice.

References #

– Joint Royal Colleges Ambulance Liaison Committee (JRCALC)
– Institute of Health Care Development paramedic manual, IHCD 2007
– Institute of Health Care Development technician manual, IHCD 1999
– Health Care and Professions Council standards documents
– Nursing and Midwifery Council code and standards documents
– General Medical Council: Standards Guidance for Doctors

Outline Scopes #

Ambulance Care Assistant Scope #

First Responder (FREC 3) #

First Responders (FREC 4) and Emergency Care Assistant Scope #

Emergency Medical Technician #

Paramedic #