Much has been made about the skill and employment mix in general practice in recent times. Pharmacists, associate physicians and nurses have all come under the spotlight. But what about paramedics? Do they have a role to play in easing practice workloads and the pressures of recruiting new GPs?

The short answer is yes – there’s growing recognition that paramedics can become an integral part of the practice team. A report by the Primary Care Workforce Commission – The future of primary care, Creating teams for tomorrow – and NHS England’s General Practice Forward View, both recognise the potential of paramedics working in practices. But what sorts of roles can they perform and how can they help practices?

Paramedic roles

A number of threads on this topic have appeared on the Practice Index Forum this year as practices start to think about the skill mix within their practices – click here to read more. From those threads it’s clear practices are utilising paramedic skills for home visits, urgent care clinics, treatment provision and triage, amongst others.

One practice that we spoke to explained that, after reading a news article about a practice that had successfully employed a paramedic for a number of months, they copied their model. This entails using the paramedic’s skill in the morning in a minor ailments clinic as part of an acute access team led by an on-call GP, but with a nurse practitioner, pharmacist and paramedic delivering the majority of treatment. The afternoon is then spent doing home visits that would have been covered by a GP. These visits tend to be to housebound patients, those in residential homes and to patients with pre-existing conditions who need treatment.

“Our paramedic is working well and although our decision to appoint one was forced by the being unable to recruit a GP I’m pleased we’ve done it,” the PM told us. “In fact, our plan is to recruit another paramedic to support us our practice grows.

“By saving our GPs time – they used to spend so much of their day travelling – we’ve actually been able to get an extra session out of each of our three GPs, which is clearly a terrific result. We also find that our paramedics are better suited to being out and about because that’s what they’re trained to do! We’re all about playing to the strengths of our staff.

“Finally, patients are fine with it – we haven’t had one negative comment about a paramedic delivering care rather than a GP.”

If you are thinking of following suit, here are some handy hints and things to think about.

Be clear about the role

The first step in deciding if a paramedic is right for you is working out where they will fit into your team, what skills they will bring to their role and what their job will be. Helpfully, a number of job descriptions have been made on the Practice Index Forum – find them using the link above. There’s also a handy discussion about salaries.

In addition, ensure your wider team are aware of how paramedics will fit into the team. This will ease induction and ensure there’s no duplication of effort.

Skills and experience

If you do decide to recruit a paramedic, it can be handy if they have experience of primary care delivery – such as GP out-of-hours provision. As they’ll most likely be out and about dealing with people, ensure they have excellent communication and listening skills as well as relevant qualifications.

Ongoing training and CPD is also necessary, as it is with all practitioners, so factor in the cost and time out of regular courses.

Medical indemnity insurance

Paramedics require medical indemnity insurance, so let your provider know that you are employing one.

Use technology to help

You’ll have to work out how autonomous you would like your paramedic to be. In some cases it can be beneficial to have phone or video links between paramedic and GP – that way a three-way conversation between patient, paramedic and GP can be set up to support the paramedic.

Other practices prefer their paramedics to close calls themselves in as many cases as possible, which will include admitting patients to hospital or creating a care plan. Much of this decision will come down to the paramedic’s experience and skills – and how much risk they and you are willing to take.

Prescription problems

The main drawback to paramedics and how autonomous they can be is the fact they can’t currently prescribe. This therefore means links with other members of the team who can, is vitally important.

Discussions about this are thought to be ongoing, and it’s hoped that paramedics with the necessary qualifications who have completed the right courses will soon be able to prescribe, utilising their skills to the full.

While the number of paramedics in general practice is still small, interest in their role and the benefits to practices is increasing. While the GP shortage continues to be a problem and practices look to new ways to deliver care, paramedics could become a much more common sight over the coming months.

Do you employ a paramedic or are you considering hiring one? If so we would love to hear your thoughts. Please share them below or in the Practice Index Forum here.

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