How do we achieve professionalisation of the paramedic? The Trait theory identifies profession as having 1. An exclusive body of knowledge 2. Self regulation and 3. Registration. Becoming a profession leads to improved remuneration and greater respect and knowledge, but this does not lead to a change in personal conduct. Professionalism however, is connected to behaviour, attitudes, accountability and responsibility. The behavioural changes and attitudes required of a ‘professional’ are brought about through the combination of higher education and clinical leadership. Academic input integrates clinical leadership with the career structure and all staff at all levels. Clinical leaders are at the coal face, accessible during and after the event, for training and clinical supervision and are therefore transforming practice at every level.However, clinical leadership is ineffective with an uneducated workforce and an uneducated workforce is ineffective without clinical leadership, thetwo go hand in hand So... What is the way forward for the ambulance service? What are paramedics doing to develop and maintain the profession and professional

Advanced clinical practitioners are in demand in primary care. This study looked at the experiences of participants in a hub and spoke training model using a qualitative approach Background: Advanced clinical practitioners (ACPs) have been fundamental in ensuring the provision of expert care, resulting in an increase in demand in primary care. This demand has incentivised innovation in approaches to education, to maximise the benefits of training with limited resources and harnessing the expertise in the workforce. Aim: To develop a method of educating and supervising advanced clinical practitioners in training (ACPiTs) in primary care settings situated in a novel hub and spoke environment. Methods: A qualitative approach with close methodological links to the philosophical work of Heidegger was used to capture the nature of existence and reality in the hub and spoke environment. Results: Three main themes emerged from the study: support; supervision; and vision. Conclusion: The hub and spoke format of training is a useful alternative to traditional methods in developing practitioners who work in a bespoke yet broad practice environment, such as primary care.

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