Building a sustainable paramedic workforce in a changing system

Kirsty Lowery-Richardson, Head of Education at the Royal College of Paramedics, has spent more than 25 years in the profession. Starting as an Emergency Medical Technician (EMT) before the degree era, she progressed through roles in education and workforce development, eventually joining the College in 2023. Her career has spanned ambulance trusts, universities, and national workforce transformation initiatives, giving her a broad perspective on the challenges and opportunities facing paramedics today.

Workforce dynamics have shifted dramatically in recent years. For the first time in decades, paramedic graduates in 2025 faced a shortage of available roles. Funding freezes, fewer retirements and limited opportunities for advanced practice positions meant that while supply of qualified paramedics increased, demand had not kept pace. Historically, shortages were the main concern, but now the system faces the unusual situation of over supply in certain areas.

“If you’d asked me a year ago, I would have said we had an issue with numbers. We were always under-supplied. This is the first time in a long time that we’ve seen the opposite.”

Retention remains critical, but the challenge has changed. Many paramedics are staying in the profession but moving into wider roles beyond ambulance services. Today, paramedics can be found in hospice care, emergency departments, intensive care units, primary and community care, and even in prisons or on cruise ships. The profession has evolved from being almost exclusively ambulance-based to one with broad clinical reach, provided the right education pathways and governance are in place.

Clear career pathways are essential to sustaining the workforce. The College publishes a career framework based on four pillars: clinical practice, education, research and development, and leadership and management. These routes are rarely linear, with early-career paramedics often working across multiple domains. Articulating opportunities across all four pillars not only supports professional growth but also strengthens retention by showing a long-term future within the profession.

Training has evolved alongside the role. The College’s sixth edition curriculum, published in 2024, was designed to ensure paramedics are ready for the realities of modern practice. At registration, paramedics must be able to respond independently to unpredictable, undifferentiated cases, whether in an ambulance or response car. With 84 programmes delivered by 51 universities, variation had previously led to uneven preparation. The updated curriculum sets a clearer national baseline, while employers are expected to build on this through structured induction and ongoing development.

Despite improvements, gaps remain. Paramedics now serve an older population living with multiple comorbidities and complex medication regimes. They are expected to manage social care issues, mental health presentations and chronic disease, while also remaining highly skilled in resuscitation and major trauma. Compressing that breadth into a three-year degree is a constant balancing act.

“We can’t just expect individuals to be resilient and leave it at that. Organisations have to create a safe culture and manage expectations realistically.”

Leadership and wellbeing sit at the heart of this conversation. Effective leadership in paramedic teams extends beyond job titles or hierarchy. Leadership identity is now introduced during pre-registration training, reinforcing the idea that responsibility and influence begin early in a career, not at a certain pay band. At the same time, there is growing recognition that resilience should not be used as a catch-all solution. Organisational responsibility, supportive culture and proactive wellbeing systems are equally important.

Digital transformation adds another layer of complexity. As ambulance services adopt electronic patient records and explore AI-supported decision-making, paramedics must develop digital literacy alongside clinical expertise. The College approaches artificial intelligence with cautious optimism, viewing it as an enabling tool rather than a replacement for professional judgement. The rapid pace of change is already influencing education, particularly around assessment and academic integrity, highlighting how quickly both practice and training environments are evolving.

Major incident response remains one area where learning consistently translates into practice. Structured training and strong inter-agency collaboration mean that when incidents occur, teams are able to shift from routine operations into coordinated emergency mode effectively. It is, Kirsty suggests, one of the areas the profession continues to do particularly well.

Taken together, the themes of workforce supply, career development, leadership and digital change point to a profession in transition. The paramedic role is broader, more integrated and more complex than it was two decades ago. Ensuring education, organisational culture and workforce planning keep pace will be key to building a sustainable future for paramedics and the communities they serve.

These questions around workforce supply, leadership and career development will form part of the wider conversation at The Emergency Services Show 2026, where building stronger teams through training, wellbeing and leadership is a core theme. As services navigate shifting workforce pressures and increasing complexity, the focus is turning to how organisations can better support paramedics at every stage of their careers.

Click here to register your interest for The Emergency Services Show and join the discussion.

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