With a population of 65 million, the United Kingdom (U.K.) is a high-income country consisting of four constituent countries: England, Scotland, Wales, and Northern Ireland.1 Public healthcare in the U.K. is state controlled through the National Health Services (NHS) in England, Scotland, and Wales, while the affiliated Health and Social Care (HSC) provides service in Northern Ireland.2
Residents pay a national health insurance premium as part of their income tax deductions to access “free” health services.2 Limitations and restrictions exist in some related areas, such as eye, dental, and podiatry care. There are numerous private healthcare companies that provide a niche market for specialized care or where paying customers can circumvent NHS waiting times.
Emergency care remains largely within the ambit of the NHS (by calling the national emergency number, 9-9-9), with 10 NHS ambulance service trusts in England and one each in Scotland, Wales, and Northern Ireland. Private ambulance companies provide patient transport and special event services.3 Smaller public ambulance services are responsible for island and overseas territories such as the Isle of Wight, Isle of Man, Guernsey, Jersey, and Gibraltar.3
The Health & Care Professions Council (HCPC) is the national professional, statutory, and regulatory body for the paramedic profession, with a single register in place since 2000 to administer the title of paramedic, protected since 2001.4,5 Their goal is to set standards for professional education, training, and practice and to administer the register of those meeting these standards and act on those who do not.4
Many different qualifications would historically meet the entry requirements for the paramedic register; however, the first standard of education and training change (SET 1) will take effect on Sept. 1, 2021, after which only those with an undergraduate degree (BScHons) may be considered for registration.4 Other ambulance staff, such as assistants and technicians, are currently unregistered in the U.K., although the nonstatutory voluntary registration organization UKREMT (like the NAEMT in the U.S.) is gaining popularity.6
The peak professional body is the College of Paramedics, previously the British Paramedic Association, established in the early 2000s. The college represents its members through professional support in areas of continuing professional development opportunities, clinical practice, standards, education, and research.5
Ambulance services in the U.K. began to take training in earnest in the early 1970s, with experimental paramedic schemes trialled by the NHS across various trusts.5 Initial training occurred at that level, with the first part-time university undergraduate program starting at the University of Hertfordshire in the late 1990s. Multiple programs were designed to meet the requirements of the regulator, with qualifications ranging from a one-year foundation degree or two-year diploma to a three-year undergraduate bachelor’s degree with honors.4
These qualifications are achieved via two pathways: vocational employment in a trust or pre-employment through direct entry to universities. However, apprenticeship provisions are being developed to bridge this divide.2 There are currently 66 programs approved by the HCPC, with 36 university and three private or trust providers.4
Postgraduate education in specialized areas is a growing area of demand.5 According to the College of Paramedics career framework, specialist paramedics should attain a postgraduate certificate or diploma, advanced paramedics should attain a master’s degree, and consultant paramedics should reach doctoral-level education.5 There is a keen interest in further research, with a reported nine U.K. paramedics achieving doctoral qualifications and another 23 in the process.7
The NHS is the primary provider of out-of-hospital emergency care across the U.K., with local private companies providing a supportive role mainly at events and for interfacility transport. Charity organizations such as the British Red Cross, St. John Ambulance, National Sea Rescue Institute, etc. provide a unique function assisting the NHS and delivering basic first aid training.
Some charity organizations have a more direct helping relationship with the NHS by bringing specialist resources such as helicopters or fast-response vehicles with physician-led clinical staff to the out-of-hospital setting. Most of these charities or volunteers align themselves with the British Association of Immediate Care (BASICS) to provide skilled medical help to the sites of accidents and emergencies or in transit.8
Upon completion of an educational program and registration, paramedics must undergo a consolidation-of-learning or internship program with their employer, known as the Newly Qualified Paramedic (NQP) program.9 This program was initiated in 2017 to help new paramedics transition into clinical practice under mentor guidance and show proficiency by maintaining a practice portfolio. NHS salaries are fixed in bands and starting as an NQP would place you on Band 5, with an annual salary of roughly U.S. $31,000–$38,600.
Once sufficiently qualified, usually accompanied with a mentorship qualification and completion of a four-week driving course, new providers advance to Band 6, with an annual salary starting from U.S. $39,000–$47,800.10 Advanced or entry officer posts are usually at Band 7, with more senior managerial posts ranging from Bands 8A–8D, with the highest being Band 9.9
The HCPC as regulator does not set scopes of practice or clinical practice guidelines; this is up to each individual trust. However, guidance is provided by the Joint Royal Colleges Ambulance Liaison Committee (JRCALC), which offers regular clinical updates for trusts to use as guides.11
There are a range of specialist areas a paramedic can explore in the U.K.: working in emergency operations centers, on helicopters, with hazardous-response teams, on motorcycle squads, at remote sites, with the military, with general practitioner surgeries, in hospital accident and emergency units, and in education, to mention just a few. This flexibility allows paramedics in the U.K. to go beyond the traditional pathways, enabling greater community impact in this emerging profession.
1. GOV.UK, www.gov.uk.
2. National Health Service, www.nhs.uk.
3. Association of Ambulance Chief Executives, https://aace.org.uk.
4. Health & Care Professions Council, www.hcpc-uk.org.
5. College of Paramedics, www.collegeofparamedics.co.uk.
6. U.K. Registry of Emergency Medical Technicians, https://ukremt.co.uk.
7. Paramedic PhD, www.paramedicphd.com.
8. British Association for Immediate Care, www.basics.org.uk.