While paramedics can now be found in many primary and urgent care settings across the UK, standardised training is lacking and their diverse roles may not always lead to reductions in GP workload, finds research from a team in the Nuffield Department of Primary Care Health Sciences.
The move of paramedics into community settings follows encouragement by both the recent NHS Long Term Plan and the new five-year framework for GP contracts, as well as the Additional Roles Reimbursement Scheme, which outlines funding support for 'advanced paramedics’ to be employed.
Published today in the British Journal of General Practice, the systematic review of 24 research studies, carried out before the coronavirus pandemic, describes paramedics working in a variety of primary care clinical settings, including general practice, home visiting services, first aid units, minor injury units, walk-in-centres and out-of-hours services. The review also finds that many paramedics take on a rotational role into primary care whilst retaining the ambulance service as their main employer.
Paramedics in primary care are often reported to potentially decrease general practitioner workload as they take on the assessment and treatment of urgent, non-complex patients. However, the researchers point out that issues with patient management and the requirement for clinical supervision can extend patient consultation times, increase steps in the patient journey and so the impact general practitioner workload is unclear.
The lack of a clearly defined role has implications for the provision of standardised training and workforce applications suggests lead author and advanced paramedic, Georgette Eaton, whose DPhilin Evidence-Based Health Care at the University of Oxford is supported by a NIHR Doctoral Research Fellowship.
'While we can be confident that the role of the paramedic in primary care is being advocated and implemented across the UK, it’s becoming clear unresolved challenges remain. Unconventional job titles and the emergence of ill-defined roles for paramedics in primary care is going to make it difficult to develop training programmes that adequately prepare them to work in these community settings, as well as make it confusing for patients who may see a paramedic instead of their General Practitioner.'
Fellow researcher Dr Kamal Mahtani, a GP and Associate Professor added: 'Increasing access to general practice has been one of the core themes of recent NHS policy. This includes broadening the clinical workforce, as we are seeing in primary care networks. Paramedics, who already have a track record in providing flexible and innovative generalist care, are a growing part of this workforce. However, robust evaluations of how, why and under what circumstances their skills can be optimally deployed are needed. This is something we will look at in the next phase of our work.'
The study was led in the Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences and supported by NHS Health Education England and the NIHR including the School for Primary Care Research Evidence Synthesis Working Group [project 390].
Contribution of paramedics in primary and urgent care: a systematic review
Georgette Eaton, Geoff Wong, Veronika Williams, Nia Roberts, Kamal R Mahtani
BJGP, DOI: https://doi.org/10.3399/bjgp20X709877