Pay survey reveals two thirds of paramedics considering leaving ambulance service

Adobe Spark (5)Two thirds of staff say they will consider leaving the ambulance service if a change to the pay banding of paramedics is not made, according to a survey carried out by the Journal of Paramedic Practice.

An online poll completed by 1084 paramedics has revealed that 67% will consider leaving the ambulance service if the Government continues to fall back on its 2015 promise of reviewing the banding system to recognise the skill set of paramedics. Additionally, 87% felt the Government has misled ambulance service staff over promises for pay.

One respondent said: ‘Increased pressure to use alternative pathways, treat at home, discharge on scene. Increased level of assessment and treatment options, together with increased expectation of qualifications and study, but for no extra pay? Ridiculous.’

Another said: ‘Several of my colleagues and friends are struggling to pay their home bills and have left the job for better paying roles in the Arab states.’

Commenting on the findings, Gerry Egan, chief executive officer for the College of Paramedics, said:

‘Since its establishment, the College of Paramedics has worked hard to develop the paramedic profession in the interests of providing the best possible care to patients and to ensure that paramedics receive due recognition for the service they give to society.

‘This combined with the increased reliance on paramedics by the health system, which has come about for a number of reasons, means that there has been a continuous increase in the expectations of the range and quality of services that paramedics provide. So it comes as no surprise that the results of the Journal of Paramedic Practice’s survey are similar to a survey conducted by the College of Paramedics last year.

In 2014, paramedics were among the thousands of health professionals who took to the picket line in the first NHS strike over pay in 32 years.

The dispute came as ministers in England awarded NHS staff a 1% increase in pay, but only for those without automatic progression-in-the-job rises.

Despite the independent NHS Pay Review Body recommending a 1% rise across all pay scales, ministers claimed this was an ‘unaffordable’ cost.

In a desperate effort to resolve the pay dispute of 2014/15, the Secretary of State for Health, Jeremy Hunt, agreed to a number of commitments to ambulance staff, including a review of the banding system.

Current vacancy rates for the paramedic profession are at 10%. This represents 1 250 vacancies out of a total workforce of 12 500. It is believed that these high vacancy rates are due to changes made to the healthcare system in recent years. This includes a shift in focus to treat patients at home rather than conveying them to A&E, as well as a change in the nature and volume of job opportunities for paramedics.

Almost all respondents (93%) of the survey believed that the current scope of practice of paramedics is changing as a result of increased skills and competencies. Additionally, 94% felt band 6 of the Agenda for Change pay scale was a more appropriate pay band due to the level of responsibility and autonomy practised within the paramedic role, including triage, referrals, and decisions around non conveyance. Overall, 96% believed their pay did not reflect their responsibilities.

However, not all believed that current pay for paramedics has contributed to increasing vacancy rates and the number of people leaving the profession.

‘I disagree that this would be a reason for paramedics leaving,’ said one respondent. ‘With the role having changed so much, I believe that our advanced practice colleagues (paramedic practitioner/emergency care practitioner) are leaving to work in hospitals. There is potential to earn more money, better chance of a break, and better working conditions. I disagree that pay alone is a reason staff are leaving.’

According to Egan, the significance behind the figures for those considering leaving the profession may be unclear:

‘The responses regarding those intending to leave their positions as paramedics may be blurred somewhat between those intending to leave ambulance service employers and those who might leave the profession,’ he said. ‘It is a well-known fact that many paramedics are leaving ambulance services to take up opportunities in walk-in centres, minor injuries units and the like.’

A large number of respondents felt that it was work pressures and stress that have contributed most to the number of paramedics leaving the ambulance service:

One respondent said: ‘I don’t think pay is a factor in staff leaving. Lack of retention [is] more likely due to increased workloads, poor culture and public expectation.’

Another respondent said: ‘There have been some paramedics with MSc or BSc that have left to find better paid jobs. But the majority of paramedics leaving the profession is due to the increasing workload and the undertaking of urgent care alongside emergency work. Demand, stress and pressure are why paramedics are leaving, not money.’

Stress and burnout remain an undeniable issue facing ambulance staff, with paramedics in England taking 41 243 days off in 2014 as a result of stress-related illnesses. This has had an inevitable impact on those choosing to leave the ambulance service. Only a handful of ambulance services have agreed to pay paramedics Agenda for Change band 6 in the hope of recruiting and retaining paramedics .

Another significant finding was that 66% of respondents believed there are no adequate opportunities for career progression.

A common consensus was that progression only came in the form of management positions, with few opportunities for promotion in a clinical capacity.

One respondent said: ‘There are a number of areas within the paramedic profession to progress to, such as critical care roles or minor health roles, or management; however, these areas still do not have the same pay scale as other health sectors, meaning progression, while increasing skills, does not increase pay, therefore [it] is seen as a way to gain skills in order to leave to a sector with increased pay.’

However, this was not felt by all, with one respondent highlighting the work that the College of Paramedics has done to outline career pathways:

‘The College of Paramedics (and South East Coast Ambulance NHS Foundation Trust) has done a lot to develop career pathways. Integration of the out-of-hours providers and the ambulance service would provide even more opportunity for paramedics to progress as well as improving the response times for patients.’

Commenting on the suggestion there are insufficient career progression opportunities within the paramedic profession, Egan said: ‘The College would argue that its career framework sets out the roadmap for career progression and the shortage of opportunities may be a problem to be addressed by the main employers of paramedics.’

As a result of the Government not reviewing the banding system for paramedics, the unions UNISON, GMB and Unite conducted consultative ballots of ambulance staff. The responses indicated that ambulance staff in England will take part in industrial action, including strike action, if the Government continues to not deliver in its promises over pay.

Each union is reporting their ballot results to members, before consulting over the next steps.

Results published by Unite show that 66% of members voted yes to taking strike action and action short of strike action, with a turnout of 31%.

Results from the other two unions have not yet been made public.

A joint statement issued by the unions said:

‘We are clear that ambulance staff have waited for 12 months and are not going to wait longer. If possible, we would also like to avoid a dispute, and the disruption that strike action will bring, however we know that ambulance staff are not prepared to wait indefinitely.

‘We will be calling on Government to make real commitments to ambulance staff, within clear timescales. If there is a genuine will to avert a dispute then we will pause the move to a full industrial action ballot while we hold constructive discussions.’

While the National Ambulance Strategic Partnership Forum have made a formal request to the National Job Evaluation Group to look at the National Job Evaluation paramedic profile, only a handful of ambulance services have agreed to pay paramedics Agenda for Change band 6 in the hope of recruiting and retaining paramedics. This includes East of England Ambulance Service NHS Trust, West Midlands Ambulance Service NHS Foundation Trust, Yorkshire Ambulance Service NHS Trust. There is currently no indication that other services will follow suit.

Taken from Journal of Paramedic Practice, published 1 July 2016.

Addressing the burnout issue

Last month a special report on the issue of burnout among ambulance staff was published by the Larrey Society (2015), the cross-sector think tank for emergency medical services. Within the report, the society urges all NHS ambulance Trusts, independent companies and voluntary organisations to adopt a 7-point code of practice on work life balance designed to improve the working environment of all employees in the ambulance service. Specifically, the code calls on all Care Quality Commission regulated ambulance providers to:

  • Form a special work life balance task force comprising representatives of management and employees
  • Conduct an organisation-wide consultation programme in order to identify the extent that employees and their families are affected by the consequences of ‘burnout’
  •  Draw up and implement an action plan which includes the introduction of key performance indicators (KPIs), management and employee training to recognise early signs of burnout, exit interviews and access to an independent counselling service for employees and their families
  • Publicise the plan internally and externally so that all employees, their families and the public at large are confident that work life balance is formally recognised and is being addressed
  • Submit the plan to the Care Quality Commission as a benchmark for subsequent review at the end of years 2016, 2017 and 2018
  • Include a copy of the plan and subsequent updates, including any CQC comments, in tenders submitted to clinical commissioning groups for NHS contracts
  • Ensure all leaders are adequately trained with a professional qualification in leadership from an accredited body (NHS Leadership Academy/Chartered Management Institute/Institute of Healthcare Managers) and that specialised training in recognising employee ‘burnout’ and how they can support their employee better is provided. This should be done in conjunction with a review of policies and procedures.

The key actions were put together following the completion of an online survey by members of the Society, where they were asked to indicate issues they felt were important for the society to focus on. Burnout was identified as one of the key priority issues, with 40% of members choosing it as an area of focus. There is no denying that stress and burnout remains an important issue facing ambulance staff, with paramedics in England taking 41 243 days off in 2014 as a result of stress-related illnesses (Kirk, 2015). It is therefore welcoming that the society is seeking the support for the campaign from numerous organisations, including the Department of Health, the Association of Ambulance Chief Executives, the Ambulance Services Charity and Unison.


Kirk A (2015) Paramedics take 40,000 days off sick with stress as strain on NHS takes toll. The Guardian. (accessed 3 August 2015)

The Larrey Society (2015) The ‘Ambulance Burnout’ Issue. (accessed 3 August 2015)

Taken from Journal of Paramedic Practice, published 7 August 2015.

A healthy workforce is a happy workforce: looking after staff with the #StayingWellService

Today the South Western Ambulance Service NHS Foundation Trust (SWAFT) launches its #StayingWellService Campaign, an initiative that will provide further support to ensure the physical and mental wellbeing of its staff.

It was announced that the new service will be provided in addition to the various support mechanisms already available to staff, such as debriefings following challenging incidents. Additionally, staff will be able to use the service for problems and issues stemming from their personal life, as well as situations occurring at work which are adversely affecting them.

Some of the more common mental and physical issues encountered by ambulance staff include: stress, anxiety, financial concerns, drug or alcohol problems, physical injuries and domestic violence.

Paramedics, by the very nature of the work they do, are often exposed to traumatic and disturbing events, and so mental health problems arising from stress are commonplace. Increased demand for 999 services has also contributed to the mental wellbeing of paramedics, as staff are forced to go from one job to the next with little time to reflect and recover. Both the number of paramedics on stress-related leave and the amount of time taken have increased dramatically in the last 3 years. According to The Guardian, paramedics in England took a total of 41,243 days off in 2014 as a result of stress-related illnesses.

SWASFT report that in the few hours since its launch, staff have already been accessing the service. It is arguable, therefore, that initiatives such as this should be rolled out UK-wide, as it is questionable whether enough is being done to to support the current ambulance workforce. Anxiety, stress and depression often top the list of reasons for staff-related absence. By focusing on the existing workforce, it can go some way to alleviate pressures facing the service. Ensuring staff are fit to work is essential, so additional services such as this are sorely needed.