Diploma in Primary and

Urgent Care
Handbook

January 2024
 COLLEGE OF PARAMEDICS | Diploma in Primary and Urgent Care

Contents

INTRODUCTION 3

Purpose 3

HISTORICAL BACKGROUND AND CONTEXT 3

DIPLOMA SPECIFICATION 4

DIPLOMA INFORMATION 5
Entry Requirements 5

What does the Diploma have to offer? 5

Clinical Supervision 6

Supporting Disability 6

Enrolment Process for the Diploma 7

Fees 7

Refunds 8

CURRICULA 8

ASSESSMENT PROCESS 9
Practice Development Portfolio 9

Examination 10
Applied Knowledge Test 10
Objective Structured Clinical Examinations 11

RESULTS 11

Issuing the Diploma 12

Managing Failure 12

Appeals 12

Condonement 12

Mitigation of Extenuating Circumstances 13

APPENDIX A. ELIGIBILITY CRITERIA 14

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Introduction
Welcome to the College of Paramedics Diploma in Primary and Urgent Care
(DipPUC). This handbook outlines the rationale behind the examination, setting out
the details of the underpinning curriculum, the learning outcomes, assessment
strategies and what you need to do for successful completion of the Diploma.

Purpose

The General Practice Forward View (2016) was a commitment to General Practice in
developing new ways of working. The Interim NHS People Plan (2019) outlined the
significant role allied health professionals and nurses will play to support the demands
the NHS will face in the next ten years in order to deliver the ambitions of the NHS
Long Term Plan (2019). The commitment to ‘more staff, working differently, in a
compassionate and inclusive culture’ was strengthened and clarified in We are the
NHS: People Plan 2020/21 – action for us all (2020). Together with the NHS Long
Term Workforce Plan (2023), these documents all outline a vision for the NHS where
the professionals that deliver care will take on more responsibility and autonomy and
become more effective within their roles.

This Diploma has been developed to facilitate the standardisation of the role of the
Paramedic working in primary and urgent care. Whilst the Diploma was originally
designed with Paramedics in mind, it is suitable for candidates from other non-medical
generalist health professional groups, such as Nursing or Physician Associates
working in primary and urgent care.

The Diploma has been designed to be portfolio-based, taking into account the existing
work undertaken by healthcare professionals working in primary and urgent care
environments.

Attainment of this diploma will demonstrate capability and competence in independent

practice within primary and urgent care.

Historical background and context

The Diploma was initially developed in 2009 by South East Coast Ambulance Service
NHS Foundation Trust to ensure standardisation for their paramedic practitioners
working to a specialist level of practice dealing with a significant breadth of
presentations in the community with little tangible clinical support. Running over many
successful cohorts, these paramedics worked within the ambulance service or within

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primary care settings primarily across the South East of England. In 2017, the
intellectual property rights to the exam were handed to the College of Paramedics to
take it forward as a multi professional award to continue to offer safety and
standardisation of clinical practice in primary and urgent care.

The exam has been independently assessed three times since its inception by
examiners from the Royal College of General Practitioners. In 2021 the DipPUC was
reviewed and mapped to Health Education England’s Roadmap to Practice for First
Contact Practitioners and Advanced Practitioners in Primary Care and the Core
Capabilities Framework for Advanced Clinical Practice (Nurses) Working in General
Practice / Primary Care in England. There will be further mapping reviews conducted
if or when NHS England confirm any changes to the Roadmap.

Diploma Specification
The Diploma aims to:

1. Improve patient safety through the provision of a standardised examination for non-
medical roles working in primary and urgent care.

2. Provide an end point assessment for demonstration of healthcare professionals’

competence and capability working in primary and urgent care.

3. Enhance individual healthcare professionals’ continuing professional development.

The Diploma provides opportunities for candidates to develop and demonstrate

knowledge and understanding, qualities, skills and attributes in the following areas:
1. Communication and consultation skills
2. Practicing holistically to personalise care and promote public and person health
3. Working with colleagues and in teams
4. Maintaining an ethical approach and fitness to practice
5. Information gathering and interpretation
6. Clinical examination and procedural skills
7. Making a diagnosis
8. Clinical Management
9. Prescribing treatment, administering drugs/medication, pharmacology.
10. Managing medical and clinical complexity

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Diploma Information
The Diploma has been developed for healthcare professionals to demonstrate
capability and competence in independent practice within primary and urgent care.

Entry Requirements

• Candidates will be registered healthcare professionals.

• Candidates will be in a patient-facing clinical setting and able to carry out the
requirements of the practice development portfolio.
• Candidates must have access to an appropriate clinical supervisor within their
current clinical setting.
• Candidates should have an enquiring approach to professional practice and
an established commitment to continued professional development.
• Entry will be dependent on at least one supporting reference from their current
employing organisation or a professional or academic advocate, indicating
academic and personal suitability to undertake the Diploma.

Whilst there are no restrictions on time since qualification, successful candidates are
usually 3 years post qualification as a healthcare professional, have a substantive post
in practice and have worked for a minimum of one year in their current clinical setting.

A helpful flowchart is in Appendix A.

What does the Diploma have to offer?

• A Diploma that recognises the duties and roles of healthcare professionals working
within the NHS.
• A high standard of assessment delivered and managed by experienced academic
and clinical staff.
• A standardised, structured Diploma that is consistent with the needs of healthcare
professions in primary and urgent care in terms of academic development and
policy guidance.
• Access to networks of other healthcare professionals within primary and urgent
care.
• Content that promotes knowledge and competency acquisition.
• The opportunity to complete Stage 2 of Health Education England’s Roadmap to
Practice for First Contact Practitioners and Advanced Practitioners in Primary
Care.
• The opportunity to demonstrate the capability to work in primary and urgent care.
• The opportunity to develop both personal and professional skills enabling the
effective management of the range of patients that may present to primary and
urgent care.

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• The opportunity to develop the knowledge, skills and attributes commensurate with
working autonomously in primary and urgent care.
• The opportunity to receive external feedback to further develop a high level of
reflection on experience gained through practice and experiential learning.

Clinical Supervision

The General Medical Council defines a Clinical Supervisor as “A trainer who is

designated and appropriately trained to be responsible for overseeing a specified
student or trainee’s clinical work in a clinical environment, providing constructive
feedback during that training period, and informing the summative judgment at the end
of that clinical training period and/or series of periods.”1

Clinical supervision provides an opportunity for healthcare practitioners to reflect on

and review their clinical practice, discuss individual cases in depth and identify
changes or modifications to practice which are required to maintain professional and
public safety. It provides an opportunity to identify training and continuing development
needs2. Professional supervision is often interchangeable with clinical supervision or
as an overarching term to include both clinical and managerial aspects of supervision.
The Care Quality Commission (2013) suggest the term is sometimes used where
supervision is carried out by another member of the same profession or group.

Regardless of the terminology, the goal of supervision is to provide the healthcare

profession with opportunities to review professional standards, keep up to date with
profession or setting-specific developments, training and continuing development,
ensure compliance with professional scope of role, codes of conduct and boundaries.

Candidates must demonstrate that their practice development portfolio has been
verified by a trained clinical supervisor in their employment setting. Access to
appropriate training for Clinical Supervisors is available from HEE via Primary Care
Training Hubs across England, and from equivalent national bodies across the other
UK nations.

Supporting Disability

Depending on specific needs, the administrative team for the Diploma will work with
candidates to explore what additional support may be required to undertake the
Diploma. Candidates are advised to contact the administrative team at the earliest

1
General Medical Council (2015) Clinical and Educational Supervisors – UPDATE in respect of GMC Regulations August
2014, revised October 2015. London: GMC
2
CQC, (2013) Supporting information and guidance: Supporting effective clinical supervision. [online] Available at:
https://webarchive.nationalarchives.gov.uk/20140712051931/http://www.cqc.org.uk/sites/default/files/documents/20130625_80
0734_v1_00_supporting_information-effective_clinical_supervision_for_publication.pdf

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opportunity to raise any concerns: this affords both parties the maximum time to plan
what additional support may be required.

Candidates who are dyslexic or suffer from dyspraxia would usually be asked to
produce evidence of an up-to-date Dyslexia/Dyspraxia Assessment Report, which
includes specific mention of recommendations for examinations. The
Dyslexia/Dyspraxia Assessment should normally have been carried out within three
years prior to the date of enrolling on the course. This report and recommendations
must be in line with the Department for Education & Skills guidelines 3. The special
arrangements will be allowed, as far as possible, to comply with the
Dyslexia/Dyspraxia Assessment and may include either extra time for the applied
knowledge test and/or where appropriate audio or electronic facilities.

If additional help or equipment is required to prepare for and undertake the Diploma,
that is outside the remit of what the College of Paramedics can make available.

Enrolment Process for the Diploma

Candidates who wish to enrol to sit the Diploma, will submit an application form,
together with their practice development portfolio or confirmation that they are
currently working through one, and include one supporting reference from their current
employing organisation or a professional or academic advocate. Candidates can
expect an email confirming that their application submission has been received.
Larger organisations can enrol multiple candidates. All applications must be submitted
to [email protected] Once an application has been reviewed,
candidates will receive an email advising if their application has been successful. If
successful, candidates will be sent a link to an online booking page where they can
pay to enrol. The DipPUC fee can be paid in full or in instalments. If paying by
instalment, each section of the assessment process will be paid when booking
examination dates. These can be taken in any order, and the Diploma in Primary and
Urgent Care will be awarded when all three elements of the assessment processes
have been passed.

Fees

Fee: members £1,250.00 Non-members £1500.00

ENROLMENT: upon enrolment candidates will be sent hard copy resources of

three essential reading books, electronic resources which include a
Handbook, portfolio guidance, log in details for online revision resources and
candidates will be able to start completing their WBPA portfolio.
o COST £295.00 (non members £350.00)

3
The Dyslexia Guild (2019) Assessment Practising Certificate [Online]
https://dyslexiaguild.org.uk/blog/2019/04/18/assessment-practising-certificate-new-guidelines-from-the-dfe-and-sasc/

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AKT: when candidates feel ready they can book the AKT assessment date
o COST £295.00 (non-members £350.00)
OSCE: when candidates feel ready to sit the OSCE’s they can book their
assessment date
o COST £395.00 (non-members £450.00)
WPBA PORTFOLIO REVIEW: candidates can submit their portfolio to the
College for internal review when completed
o COST £295.00 (non-members £350.00)
The total cost of the DipPUC is £1,280 if paid in instalments. The cost to non-
members is £1500.00

Only electronic practice development portfolios’ will be accepted. This could be as a

PDF bundle, or external access granted to review portfolio software, such as NHS
ePortfolio, Fourteen Fish, Clarity or others.

Once an examination diet has been accepted by the candidate, this can be deferred
once to a later examination diet.

Refunds

100% of the Diploma fee will be refunded if an examination is cancelled by the College
of Paramedics and re-booking is not feasible.

Candidates who wish to withdraw their application for admission to any element of the
examination must submit a request in writing to the College. A refund of the fee paid
may be made (less an administrative fee of 20%), providing that notice of intention to
withdraw is received and acknowledged not less than 30 days prior to the exam date.

Curricula
The Diploma is underpinned by a list of core indicative knowledge, core clinical skills
and key clinical presentations, investigations, and referrals. These have been defined
and published by Health Education England in their Roadmap to Practice for First
Contact Practitioners and Advanced Practitioners in Primary Care and the Core
Capabilities Framework for Advanced Clinical Practice (Nurses) Working in General
Practice / Primary Care in England.

There is currently no such guidance for professionals working in Northern Ireland,

Scotland or Wales and so the decision was made to benchmark the curricula for the
Diploma to this guidance in order to provide standardisation for healthcare
professionals in primary care, and patients who receive treatment from them.

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Assessment Process
The overall assessment process takes an established triangulated approach to
assessment whereby the practice development portfolio (a demonstratable portfolio of
practice using workplace-based assessments) tests capability and the examination
tests competence. This methodology is common in medicine and is drawn from
Miller’s4 work on professional authenticity.

The Diploma should be undertaken within the backdrop of an educational programme

which maps to Quality Assurance Agency Level 7 – this could be a master’s degree
or an individual module that is commensurate with Level 7 (Scottish Credit and
Qualifications Level 11) study. The Diploma is underpinned by UK Quality Code for
Higher Education Advice and Guidance for Assessments5.

Practice Development Portfolio

The capability elements of the assessment sit within a practice development portfolio,
made up of a series of work-place based assessments (WPBA), reflective log entries,
feedback from patients and non-clinical team members. These are completed in the
clinical setting under the supervision of an appropriate clinical supervisor. These
materials have been derived from tools used by GP Specialty Trainees and adapted
from the Royal College of General Practitioners (RCGP). These are also the same
tools used within Health Education England’s Roadmap to Practice for First Contact
Practitioners and Advanced Practitioners in Primary Care.

This portfolio includes the following:

• Case-based discussion (CBD)
• Clinical examination procedural skills (CEPS)
• Clinical supervision report (CSR)
• Consultation observation tool (COT)
• Multi-source feedback (MSF): five clinical and five non-clinical
• Patient satisfaction questionnaires (PSQ)
• Personal development plan
• Reflective learning logs

For those who do not have such documentation in their workplace, the DipPUC
Practice Development Portfolio provides templates of these documents.

It is expected that applicants would demonstrate their experience through the portfolio
prior to applying to undertake the exam. Where candidates are already well

4
Miller G. E. (1990). The assessment of clinical skills/competence/performance. Academic medicine 65(9): S63–S67.
https://doi.org/10.1097/00001888-199009000-00045
5
UK Standing Committee for Quality Assessment (2018) UK Quality Code for Higher Education Advice and Guidance for
Assessments [Online] https://www.qaa.ac.uk//en/quality-code/advice-and-guidance/assessment

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established in primary and urgent care, the candidate may apply for a process of
sponsorship whereby an appropriate clinical supervisor signs a declaration stating that
standards have been met and maintained. Ambulance Trusts are also able to sponsor
their candidates, taking responsibility for confirming that the workplace-based
assessments have been completed to the required standard.

Examination

The competence element of assessment tests the application and integration of

knowledge, skills and attributes across a broad spectrum of key clinical presentations,
investigations and referrals. The examination is informed by the curriculum
corresponding to this Diploma and core clinical skills, core indicative knowledge, key
clinical presentations, investigations, and referrals outlined within Health Education
England’s Roadmap to Practice for First Contact Practitioners and Advanced
Practitioners in Primary Care and the Core Capabilities Framework for Advanced
Clinical Practice (Nurses) Working in General Practice / Primary Care in England.
This is assessed using an applied knowledge test (AKT) and a range of objective
structured clinical examinations (OSCE).

Applied Knowledge Test

An AKT is a written paper formed of 150 single best answer (SBA) questions. These
questions assess knowledge and its application to clinical scenarios and are a type of
multiple-choice question. Each question has a very brief scenario, a lead-in question
and five potential answers. The candidate is required to select the best answer from
the five options given.

The exam is not a test of isolated facts or retention of knowledge. There are no
“true/false” type questions or negative questioning. There is only one best answer to
each question and the candidate will, providing they have the knowledge, confirm the
answer by looking at the given options. On occasion, the candidate may consider two
answers to be correct. When this happens, it is the single best and most compelling
answer within the context of the scenario given that should be selected.

Questions in the AKT are standard set using the Angoff method. This calculates a cut-
off mark based on the performance of candidates in relation to a defined standard
(absolute) as opposed to how they perform in relation to their peers (relative). It
involves a judgement being made on exam items (test-centred) as opposed to exam
candidates (examinee-centred) and is widely used to standard set high stakes
examinations.

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The performance of every question is reviewed using borderline regression before the
results are finalised in order to check whether there have been any unintended
problems with any questions (for example, there does not appear to have been a
single best answer). If problems are found, the question is removed from results.

Examples of the AKT are found in the Preparing for the Diploma pack.

Objective Structured Clinical Examinations

OSCEs are practical scenarios that assess the knowledge, skills and behaviour used
in daily practice. There are 15 OSCE stations to be completed by each candidate,
each lasting 10 minutes. Each OSCE will assess a particular construct (for example
history taking) and every station will assess several competencies within this construct
(for example: communication, clinical content, empathy).

The mark sheet is made up of a number of domains that assess the candidate in a
complete, individual and holistic way. Domain-based assessment captures both the
competency and nuances of experienced practitioners. The importance and relevance
of each domain is weighted in advance by the exam writing group. This approach to
OSCE marking ensures candidates are not assessed on a single factor, but as a
complete practitioner. Importantly there are no critical fails.

Each OSCE station will have its own pass mark and it is also important to note that
each of the domain weightings (as a percentage) is not known to the examiner on the
day of the exam. This eliminates any examiner bias towards marking either high or
low on given domains based on knowledge of their weighting.

Examples of the OSCEs are found in the Preparing for the Diploma pack.

Results

Following the verification of candidate marks at an Examination and Awards

Committee (EAC) meeting, they are approved for release by the Clinical Development
Directorate. Candidates will receive results by email, with a personalised report that
profiles their performance within the examination group and highlights areas of relative
strength and weakness within their practice.

The College of Paramedics is responsible for producing the certificate and these will
be processed following successful completion of all elements of the Diploma. It is
important that the information requested at time of application is correct to ensure that
candidates receive an accurate certificate detailing their achievement.

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Awarding the Diploma

The College of Paramedics awards the Diploma in Primary and Urgent Care. This
Diploma is not a credit-bearing programme but is commensurate with level 7 of the
Framework for Higher Education Qualifications in England, Wales and Northern
Ireland and level 11 of the Framework for Qualification of Higher Education Institutes
in Scotland.

Managing Failure

Candidates who fail to meet the required standard within the assessment will be given
a personalised report that profiles their performance within the examination group,
highlights areas of relative strength and weakness within their practice, this can be
used by candidates to develop an action plan.

Where one element is failed it is only that element in its entirety that needs to be
retaken, which will incur the payment for that element. Where both elements are failed,
both elements are required to be retaken in their entirety. Prior to resubmitting an
application to re-take the Diploma, the candidate will need to provide evidence of
remedial action within their Practice Development Portfolio.

Appeals

Candidates may request a review of the examination process if they have reason to
believe that there may have been an error in their result for an assessment.

Candidates who are not satisfied with the outcome of this review have the right to
appeal. An appeal will always involve a meeting of the appeals panel if there is judged
to be a prima facie case.

Candidates who wish to appeal their mark should review the Regulations for the
Conduct of Appeals document. This sets out the process for the management of
appeals for the Diploma in Primary and Urgent Care within the College of Paramedics.

Condonement

Where a candidate fails an element or elements, but claims that this was due to
extenuating circumstances, the Appeals Panel may condone such failure and permit
the candidate to undertake some or all of the assessment at a later date and without
further charge.

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Mitigation of Extenuating Circumstances

The term mitigation is used to describe action taken in recognition of extenuating

circumstances which cause exceptional interference with performance and which are
beyond the normal difficulties experienced in life. This includes circumstances such
as sudden, severe, illness (confirmed by medical certificate) adversely affecting
performance or preventing attendance at the examination.

Extenuating circumstances do not include where the candidate was directly

responsible for the circumstances, or where a candidate could reasonably have
avoided the situation or acted to limit the impact of the circumstances.

The following are examples of circumstances which would not be considered relevant
for concessionary treatment; however this list is not exhaustive:
• Normal employment commitments.
• Failure to plan appropriate travel to undertake the Diploma.
• Students have been affected by long-standing, controlled conditions for
which they may be expected to have sought and received appropriate
support.
• Students have been directly responsible for the circumstances put forward
in mitigation.

Mitigation of Extenuating Circumstances applications will be considered only if

submitted:
• By means of the Mitigations Application Form designed for the purpose
• With a clear and concise account of the concessionary circumstances and
inability to perform well in the examination.
• With all necessary documentary evidence.
• Within the applicable deadline, i.e. within five working days of the event to
which the mitigation of extenuating circumstances application pertains,
where the circumstances were not anticipated.

NB. Legitimate concessionary reasons include incapacitating medical problems or

exceptional misfortune and do not include holiday plans. Any medical documentation
submitted to support mitigation of extenuating applications must be specific, relate to
the dates and duration of illness and be presented in plain English.

~~~~~~~~~~~~~~~~~~~~

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Appendix A. Eligibility Criteria

Applicants must be:

1. Registered healthcare professionals
2. Practicing currently in primary or urgent care
3. And have access to clinical supervision

Are you 3 years post qualification

as a healthcare professional and
worked for a minimum of one year
in your current clinical setting?

Not Eligible
Do you work in
Do you work
Northern Ireland,
in England?
Scotland or Wales?

If you are using the DipPUC to evidence

any aspect of the FCP Roadmap
competencies, please check NHSE WTE’s
current requirements

Have you completed, or are working to

complete a Practice Development
Portfolio?

Do you have a supporting reference from

your current employing organisation or a
professional or academic advocate?

You’re Eligible!

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