Crew clinical scope and competency policy (patient transport)

1. What the regulation says

Sufficient numbers of suitably qualified, competent, skilled and experienced persons must be deployed in order to meet the requirements of this Part. (Reg 18(1): the headline duty)

receive such appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform. (Reg 18(2)(a): support, training, supervision and appraisal)

Regulation 12 adds the safe-care duty that governs clinical scope:

ensuring that persons providing care or treatment to service users have the qualifications, competence, skills and experience to do so safely, (Reg 12(2)(c) (staff competence))

The full text is at https://www.legislation.gov.uk/uksi/2014/2936/regulation/18 and https://www.legislation.gov.uk/uksi/2014/2936/regulation/12. Where this policy and the regulation diverge, the regulation wins.

2. Plain-English summary

You have to deploy enough suitably qualified, competent, skilled and experienced staff to meet Part 3. Staff have to receive appropriate support, training, professional development, supervision and appraisal. Where staff are health or social-care registered professionals, they have to be enabled to give their regulator evidence of meeting professional standards.

3. Purpose

This policy sets out how the Service defines crew clinical scope, checks competency, records training and responds when a crew member works outside their agreed role.

The Service must verify this policy against the current JRCALC edition, HCPC standards, Skills for Care Care Certificate standards and CQC Regulation 18 source material before adoption.

4. Sources to verify before adoption

• Current JRCALC clinical practice guidelines, held or accessed by the Service through its own subscription or local arrangement.
• HCPC standards of proficiency for paramedics: https://www.hcpc-uk.org/standards/standards-of-proficiency/paramedics/
• HCPC check the register: https://www.hcpc-uk.org/check-the-register/
• Skills for Care, Care Certificate standards: https://www.skillsforcare.org.uk/Developing-your-workforce/Care-Certificate/Care-Certificate.aspx
• Skills for Care, Care Certificate standards PDF: https://www.skillsforcare.org.uk/resources/documents/Developing-your-workforce/Care-Certificate/Care-Certificate-Standards/Care-Certificate-standards-March-2025.pdf
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 18: https://www.legislation.gov.uk/uksi/2014/2936/regulation/18
• CQC guidance on Regulation 18 staffing: https://www.cqc.org.uk/guidance-providers/regulations/regulation-18-staffing

5. Scope

This policy applies to:

• registered paramedics employed or contracted by the Service
• registered nurses or other registered healthcare professionals used on patient transport jobs
• emergency medical technicians, ambulance technicians and associate ambulance practitioner roles where the Service uses them
• ambulance care assistants
• driver-only roles
• office staff who allocate Crew to jobs
• bank, agency, subcontracted or temporary Crew
• training, supervision, competency and scope-of-practice records

The Service does not use this policy to expand a role beyond the person's qualification, registration, local competency sign-off or current clinical governance approval.

6. Role scope framework

The Service keeps a role-scope matrix for every crew role.

6.1 Registered paramedic

The Service verifies that each paramedic:

• appears on the HCPC register before clinical deployment
• works within their current HCPC scope of practice
• keeps relevant JRCALC knowledge current for the duties assigned
• has local sign-off for equipment, medicines, assessment and transfer duties used by the Service
• records continuing professional development where the Service requires evidence
• escalates when a transport request requires skill, equipment or decision-making beyond their role

The Lead Clinician checks HCPC registration at recruitment, before renewal deadlines and when any concern is raised.

6.2 Registered nurse or other registered healthcare professional

Where the Service uses a registered nurse or another registered healthcare professional, the Clinical Lead records:

• professional register checked
• role agreed for PTS work
• clinical tasks allowed
• medicine or device permissions
• supervision arrangement
• escalation route
• local induction completed

The Service does not assume that a professional registration automatically covers ambulance or patient transport practice.

6.3 Technician and associate roles

The Service defines the technician or associate role in writing.

The role-scope record covers:

• assessment observations the role may complete
• equipment the role may use
• medicines the role may handle or administer where applicable
• moving and handling tasks
• oxygen support allowed by local policy
• escalation triggers
• supervision needed on complex jobs
• training required before independent deployment

The Clinical Lead signs off role scope before the Operations Manager deploys the person on relevant jobs.

6.4 Ambulance care assistant

The ambulance care assistant role supports planned patient transport.

The scope may include:

• safe moving and handling
• patient comfort and dignity during transport
• basic observations where trained and locally authorised
• oxygen equipment checks where trained and locally authorised
• wheelchair, stretcher and carry-chair use
• infection prevention tasks
• communication with booking and receiving facilities
• escalation to the Lead Clinician or on-call clinical advice

The Service verifies Care Certificate completion or equivalent induction for unregistered staff where the role requires it.

6.5 Driver-only role

Driver-only roles do not carry out clinical assessment, clinical intervention or moving and handling beyond the local role description.

The Operations Manager ensures that driver-only jobs are matched to patients whose booking information, risk assessment and escort arrangements make that role safe.

If the patient presentation changes, the driver stops, contacts the control point or clinical lead and follows the escalation process.

7. Training and competency sign-off

The Service keeps a training matrix linked to role scope.

The matrix records:

• induction
• safeguarding
• infection prevention
• moving and handling
• basic life support
• immediate life support where the role requires it
• oxygen equipment and cylinder safety where used
• wheelchair restraint and stretcher competency
• bariatric equipment competency
• JRCALC update awareness where relevant to role
• driver safety and vehicle defect process
• communication and handover training

Training completion alone does not prove competence. The Clinical Lead or delegated competent assessor records practical sign-off where the task creates patient or staff risk.

7.1 Deployment approval workflow

The Operations Manager uses the following workflow before allocating a crew member to a patient journey:

1. Confirm the journey profile: record the patient's known mobility, clinical, communication, escort and equipment needs.
2. Match the role: check the role-scope matrix for the tasks each crew member may perform without direct supervision.
3. Check current evidence: confirm registration where applicable, induction, training and practical competency sign-off.
4. Resolve restrictions: identify supervised-practice conditions, expired evidence, return-to-work limits or tasks the person must not perform.
5. Approve or reallocate: record who approved the crew mix, or change the allocation where the evidence does not match the journey.
6. Reassess on change: if the patient's presentation or transport need changes, the crew stops, escalates and records the revised decision.

A rota entry is not evidence of competence by itself. The approval must be traceable to the current role-scope matrix and competency record.

8. Response to clinical skill outside scope

If a crew member performs a clinical skill outside their agreed scope, Staff record an incident immediately.

The Registered Manager and Clinical Lead:

• make the patient safe
• arrange clinical review where needed
• record what skill was performed
• identify the crew member's role, training and sign-off status
• check whether the action was instructed, improvised or misunderstood
• consider duty of candour where harm or possible harm occurred
• consider whether HCPC referral, commissioner notification or CQC notification advice is needed
• pause the crew member from the relevant task until review is complete
• assign training, supervision, policy or rota actions

The review does not treat good intent as proof that the action was safe. The Service records the reason for any return to duty or change in role.

9. Responsibilities

• Registered Manager: owns this policy, ensures staffing governance meets Regulation 18 expectations and signs off annual review.
• Lead Clinician: owns clinical scope, escalation, JRCALC currency, clinical supervision and clinical incident review.
• Clinical Lead: maintains the role-scope matrix, training matrix, competency sign-off and return-to-practice decisions.
• Operations Manager: allocates Crew only to jobs that match role, competence, vehicle, equipment and patient need.
• Crew: work within role scope, keep training current and stop work that exceeds competence or safety.
• All staff: report scope, competence, registration or training concerns promptly.

10. Recording requirements

For each deployment decision, the record must include the crew member, assigned role, journey type, evidence checked, any restriction, approver and date. The Service also keeps the following records:

• role-scope matrix
• recruitment and induction checks
• HCPC register check where applicable
• professional registration renewal evidence where applicable
• Care Certificate or equivalent induction record
• training matrix
• competency sign-off records
• JRCALC update record where relevant
• supervision records
• job allocation records
• clinical-skill-outside-scope incident records
• improvement actions and return-to-duty decisions

Records are kept in the Service governance records and are available for internal review, CQC review, commissioner review and external review where required.

11. Audit cadence

The Service uses the following Verivius default audit rhythm unless current HCPC, JRCALC, Skills for Care, CQC, commissioner or local source material requires a different rhythm:

• Before deployment: Operations staff check that the crew member is approved for the role assigned.
• Monthly: the Clinical Lead reviews overdue training, missing competency sign-off and open supervision actions.
• Quarterly: the Registered Manager and Clinical Lead review incidents linked to scope, skill, judgement or crew mix.
• Annually: the Registered Manager audits the role-scope matrix against source material, job types and patient need.
• Per HCPC renewal cycle: the Service checks paramedic registration before continued deployment.

Audit findings are recorded as improvement actions with an owner and review date.

12. Version control and review date

The Service keeps a controlled copy of this policy. The footer or document-control table records:

• policy owner
• version number
• date approved
• next review date
• changes made since the last version
• source material checked during the review

13. Related policies and records

• Training matrix
• Role-scope matrix
• Staff record
• HCPC register check
• Clinical supervision record
• Incident register
• Improvement action register
• Training, competency and mandatory training policy
• Incident reporting, investigation and learning policy
• PTS patient assessment, fitness for transport and journey planning policy
• PTS transfer of care and patient handover policy
• PTS crew welfare, fitness for shift and driving hours policy

Review cadence: annual or on regulatory change, whichever sooner. Owner: Registered Manager.

14. Sources and further reading

This template is based on CQC's guidance for providers and managers, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and other topic-specific legislation and guidance listed below. It is a starting point for adaptation, not a substitute for legal, clinical, HR, safeguarding or specialist professional advice.

• CQC Regulation 18: Staffing
• CQC Regulation 12: Safe care and treatment
• JRCALC clinical practice guidelines (where applicable)
• HCPC standards of proficiency for paramedics (where paramedics)
• Resuscitation Council UK
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (https://www.legislation.gov.uk/uksi/2014/2936/regulation/18)

15. When to seek further advice

Seek specialist advice where the issue involves serious harm, safeguarding, deprivation of liberty, restraint, children, professional misconduct, controlled drugs, radiation, termination of pregnancy, infection outbreak, water safety, employment dismissal, DBS barring referral, or regulatory enforcement.

16. Document control

This sample policy template was issued by Verivius. It is a template, not a substitute for legal advice or the provider's own policy-development process. Where this template and live law or regulator guidance diverge, the live source wins.