PRIME service

The Primary Response in Medical Emergencies (PRIME) service aims to ensure high quality, timely access to pre-hospital emergency treatment in areas where access to appropriate clinical skills (ie, to Paramedic level) is not available, or where ambulance service rural response times may be longer than usual. The PRIME service is provided by specially trained medical practitioners, nurse practitioners, and registered nurses (PRIME practitioners) who assist the ambulance service.

It is a 24-hour a day, seven-day a week service where PRIME practitioners are on an on-call roster. Responses by the PRIME service are initiated by emergency ambulance communications centres.

The purpose of the PRIME service is to provide timely access to clinical skills that have the potential to improve outcomes for medical emergencies (including injuries) in rural areas.

Funding, for training and delivery of the PRIME service, is provided by the Ministry of Health and the Accident Compensation Corporation (ACC), and is administered by St John.

For further information visit the ACC website for a copy of the ACC PRIME Guidelines, or read more about PRIME on the St John website.

PRIME Service Review 2016

Updated July 2017

Overview

In 2016, the National Ambulance Sector Office (NASO), on behalf of ACC and the Ministry of Health, asked for formal feedback on the PRIME service. The purpose of this feedback was to better understand the issues being raised by PRIME practitioners and other stakeholders, and to establish  whether a formal review was required.

NASO received a lot of feedback from a range of sources, including St John, PRIME practices and practitioners, primary health organisations (PHOs), rural service level alliance teams (SLATs), PRIME committees, Emergency Care Coordination Teams (ECCTs), National Rural Health Advisory Group (NRHAG) members, and members of the New Zealand Rural General Practice Network (NZRGPN).

In June 2016, NASO decided to proceed with a formal review of PRIME. This was to be completed by June 2017. The scope of the review was limited to recommendations that can be implemented within the existing funding envelope.

A steering group was established to oversee the review, and was made up of representatives from NASO, ACC, the Ministry of Health, the NZRGPN, St John, the Royal New Zealand College of General Practitioners and the College of Primary Health Care Nurses.

The key objectives of the review were to create recommendations that support the development of the PRIME service so that it is:

  • dynamic: the PRIME service will be developed so that it can evolve to ensure it is safe, effective and sustainable
  • balanced, centrally and locally: the PRIME service is structured so that it allows local autonomy, but has appropriate central control as required
  • aligned to the themes in the New Zealand Health Strategy 2016: people-powered, closer to home, value and high performance, one team and smart system.

Recommendations from the review would align with the aim and purpose of the PRIME service.

The project expected to realise the following key outcomes and benefits.

  • PRIME will continue to be relevant and add value to rural ambulance services.
  • PRIME practitioners will feel well supported in their role.
  • PRIME will continue to meet its objectives in a sustainable manner.
  • PRIME funding arrangements will be well understood, with improved use of available resources.

Project structure

In August 2016, the steering group established five separate working groups to review the key issues raised in initial stakeholder feedback, and to create recommendations to address these. As a result, the working groups submitted over 190 recommendations to the steering group on 31 October 2016. These recommendations formed the platform for the findings in the steering group’s first draft report.

The scope of each working group is described in the table below.

Working groups Scope
Funding arrangements Review current arrangements and recommend a funding framework that is equitable and effective.
Administration Review PRIME administration structures and recommend an effective structure to administer PRIME, including the role of the PRIME administrator; communication; PRIME committees; PRIME sites; the role of rural service level alliance teams (SLATs); and improved data collection and analysis.
Clinical governance Review current clinical governance structures and update clinical roles and responsibilities; nurse standing orders; clinical audit; quality assurance; dispatch of PRIME and scene management.
Training and syllabus Review PRIME training and syllabus and make recommendations that will ensure future content and delivery are fit-for-purpose and content is regularly reviewed and updated.
Supplied kit, equipment, and medicines Review and make recommendations for appropriate standard-issue equipment; principles for any changes and updates; clear understanding of how items can be changed and at whose expense; medicine requirements; and safety.

The steering group acknowledges and appreciates the considerable contribution of members from the working groups who, in addition to their normal commitments, provided a range of recommendations on specific issues.

Consultation

The report went out for two rounds of stakeholder consultation. It was sent directly to a range of key stakeholders and was also made publicly available on NASO’s web page.

  • First round of consultation: 30 January 2017 to 3 March 2017.
  • Second round of consultation: 5 April 2017 to 21 April 2017.

The final report

The review’s final report, PRIME Service Review 2016: Steering Group Report to the National Ambulance Sector Office, was completed in May 2017.

The report was then presented to the NASO Leadership Team (the joint ACC and Ministry of Health governance group that oversees NASO) in May 2017 who:

  1. accepted the recommendations of the review with a caveat that any changes must be within the existing funding envelope, unless there are explicit agreements otherwise
  2. agreed that a National PRIME Committee is established, with a terms of reference and tight remit developed by NASO
  3. agreed that the terms of reference for the National PRIME Committee are submitted to a later NASO Leadership Team meeting for approval
  4. noted that the National PRIME Committee will be chaired by the National Rural General Practice Network, and have broad representation (including from NASO and ACC)
  5. agreed that the Ministry of Health and ACC will fund reasonable one-off costs in 2017/18 to implement initiatives, subject to respective agency (Ministry of Health and ACC) funding approval
  6. noted that the Ministry of Health’s share of funding for reasonable one-off costs in 2017/18 is subject to Budget 2017
  7. noted a move to a system to make medical-related funding more equitable across PRIME sites (while remaining within the current funding envelope)
  8. accepted the request for a formal review of the PRIME service funding proposed by the steering group to address sector concerns that PRIME is currently not sustainable
  9. requested that a proposal is brought back to the NASO Leadership Team on how this funding review will be undertaken, noting that any proposal would need to fit with other priorities in the NASO work programme
  10. noted that there is significant discussion about PRIME service funding being financially unsustainable and there is a risk that, if this proves to be true, a prolonged review of funding may worsen financial strain on PRIME providers
  11. noted that the national PRIME committee will consider whether there should be the standards for PRIME training developed, and how those standards would be approved, assessed and maintained.

Next steps

A work plan will be developed to implement the recommendations of the review. To do this, NASO will work closely with St John (as the PRIME administrator) and the New Zealand Rural General Practice Network (as the chair of the National PRIME Committee) who will lead much of the work.

View the Frequently Asked Questions (FAQs) on the PRIME Service, including the PRIME service review:

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