The Advanced Paramedic Practitioner project is a Welsh Government Pacesetter Project which has been developed in partnership with;

  • Betsi Cadwaladr University Health Board
  • Welsh Ambulance Services NHS Trust (WAST), and
  • seven Health and Social Care Localities (“Clusters”) within North Wales.

The project is identifying effective ways in which to integrate Advance Practice Paramedics within the wider Primary Care healthcare team so our clinicians can provide the best possible care.

‘The Pacesetter is aimed at testing novel ways of supporting Primary care.
We want to know whether our 3-part rotational model for APPs can provide another effective clinician to the multi-disciplinary team….

The aim of this pacesetter is to understand the benefits of a primary care rotation by evaluating key elements of the project, including the APPs experience, impact on WAST, Primary Care and Cluster, Patient experience and Economic evaluation.

Evaluation is being undertaken in a number of methods at a local and regional level, by members of the Project Team, Clusters and through  a formal Independent evaluation.’

Mark Timmins, Clinical Team Leader, Welsh Ambulance Services NHS Trust 

The Rotational Model

The 3 part rotational model is a means of providing a varied clinical portfolio with the aim of sustaining an ambulance service based career over a longer work span. The Pacesetter is modelled on a three part rotation which incorporates Primary Care, Clinical Contact Centre and Solo Responding. The primary care element of the rotation sees each APP spend two days in practice per week. Depending on the cluster area, APPs primary care workload will vary but tends to include home visits, care home visits and clinics in the surgery. In addition, Wednesday is reserved for formal education.

Phase I Book

The Phase I Book takes you from the start of the project in Sept to the end of Phase I in August 2020 and shares with you the plan for Phase II – this document is best viewed using use Microsoft Edge.


Series one

This series is focused on the partnership working between the Project Team, Welsh Ambulance Services NHS Trust (WAST), Betsi Cadwaladr University Health Board (BCUHB), Health and Social Care Localities (Clusters) and the Advanced Paramedic Practitioners (APPs) to develop a local model, and what we have learnt during the last 18 months.

Episode 1 – Introduction to the Welsh Government Pacesetter 

Episode 2 – Making it a Reality 

Episode 3 – The Importance of Education & Supervision 

Episode 4 – Research & Evaluation – to be added shortly 

Episode 5 – Sharing the learning 

Episode 6 – So What next?

Training & Education

Primary Care focused education and coaching is provided each week by a team of experienced GP educators, supplementing support being provided within practice. 

As part of their programme, our APPs are being supported to undertake specialist practice qualifications, including Independent Prescribing.

‘The diversity of this rotation is exceptional! I‘m learning new skills and enhancing my clinical knowledge on a daily bases! From a clinical perspective the rotation has given me more confidence and autonomy as a practitioner to safely treat patients in the community and to formulate safe patient management plans that avoid unnecessary ED admissions’

Berwyn Jones, Advanced Practice Paramedic

Evaluation & Research

The Pacesetter Project aims to examine the viability of an extended rotational approach to the delivery of care using a WAST APP based within primary care.

The Project Board was cognisant of the Critical Appraisal undertaken by Birmingham University and keen to implement the recommendations in relation to evaluation.

It was agreed that the theory of change approach leading to the use of logic models would be the framework that guides the evaluation process.  The advantage of this approach was that it enabled a complex system to be articulated in a series of logical steps and approaches, whilst still considering context and clarifying assumptions. It does this by first identifying the desired long-term goals and then works back from these to identify all the conditions (outcomes) that must be in place (and how these related to one another causally) for the goals to occur.

Public Health Wales have been instrumental in the design and development of the Evaluation Framework detailed below.

The Project Board and Project Team identified 7 elements to the Pacesetter Project that they would seek to evaluate. Evaluation was undertaken using a number of methods at a local and regional level and by members of the Project Team, Organisations, Clusters and Independent External agencies.

The 7 elements to be evaluated are as follows:

  • APP Experience
  • Impact on WAST
  • Impact on Primary Care & Clusters
  • Patient Experience
  • Economic Evaluation
  • Educational Framework Syllabus and Approach
  • Pacesetter Project Design and Deliver

Abstracts and Posters; Submissions and Publications

It’s logical to use the logic model – Developing an Evaluation Framework

Evaluation of a rotational model of advanced paramedic practice in north wales: a logic model approach to demonstrate effectiveness

PP35  Evaluation of a rotational model of advanced paramedic practice in north wales: a logic model approach to demonstrate effectiveness
  1. Duncan Robertson1
  2. Bob Baines2
  3. Gemma Nosworthy3
  4. Wyn Thomas3
  5. Mark Timmins1
  6. Robyn Watson3
  7. Stella Wright3

Background UK Ambulance Services are under pressure to retain paramedics as diverse career options become increasingly available throughout the NHS for this valuable group of staff. Rotational working is one means of providing a varied clinical portfolio with the aim of sustaining an ambulance service based career over a longer work-span. Prior to implementing a test of an Advanced Paramedic Practitioner (APP) focussed three-part model of rotation which included Primary Care, Clinical Contact Centre and Solo Responding, an effective evaluation framework was required.

Methods The aims of the project were refined during initial team planning and a project workshop which articulated the conditions for success. The theory of change was subsequently developed through a team-based facilitated session culminating in the development of a driver diagram. Due to the predominantly linear nature of the project and design, a Logic Model approach was selected to then map and construct the detailed evaluations required for each of the key areas identified.

Results Seven individual elements for evaluation were identified through this design process. These comprised of four core areas including the impact of the rotation on Patients, Primary Care, The APPs and Welsh Ambulance Services NHS Trust which would be managed by the project team. In addition, the framework identified elements suitable for external evaluation which consisted of the economic evaluation, a deeper exploration of patient experiences and project effectiveness. External evaluation would test the validity of the overall approach to the project by the internal team and stakeholders. The derived Logic Models were designed to enable formative and summative evaluation throughout the opening phase of the rotation.

Conclusions Using this approach, the project team have constructed a robust, but testable model of evaluation, with the flexibility to map changes as the evaluation yields specific learning points about the project.

Published in the BMJ Journal – Emergency Medicine Journal

More than an extra pair of hands

Health and Care Research Wales – Research Wales Conference 2020

Meet the Team

Feel free to get in touch for more information – contact us here