In primary care there are many areas where paramedics can complement the rest of the primary care team including acute care and domiciliary care that can enable patients to stay in their own home rather than be admitted to hospital.
The Paramedics in Primary Care (PiPC) project led by Health Education England (HEE) takes paramedics on a 3 year postgraduate journey to be able to work in a primary care role. Trainees elect to reduce their contracted hours with their prime employer which is often but not always an ambulance service. This allows them one day per week in practice placement at a GP surgery, plus a nominal one day per week for their Masters academic work. The programme involves support from a Clinical Fellow and Education Coordinator and a bespoke e-portfolio by Clarity Informatics.
This framework published by Health Education England provides standards for paramedics working in the primary and urgent care sectors. It helps define the role of paramedics within general practice and includes job descriptions, supervisory models and education curricula.
This framework describes advanced clinical practice for the paramedic specialist in primary and urgent care. This includes the knowledge, skills and behaviours to safely and effectively manage service users across the lifespan, recognising the need to be adaptable and working in often quite challenging situations, whilst retaining responsibility and accountability for those service users.
- enables commissioners of services to specify minimum standards for clinical employment/placement of paramedic specialists
- enables managers to demonstrate that paramedic specialists working in primary and urgent care meet core capabilities or have developmental plans in place and clinical supervision to meet the nationally recognised framework
- helps education and training providers to focus on the key capabilities that learners need to achieve, which in turn will guide the content to be included and the use of appropriate learning and teaching strategies.
- sets out clear expectations for practitioners about the requirements of effective and safe extended practice roles and transferable skills
- can be used by service users and the public to understand the expectations of the paramedic workforce in primary and urgent care and to plan effectively for their own current and future care.
The framework comprises 14 Capabilities in four domains:
- Domain A. Person-Centred collaborative working
- Domain B. Investigation, assessment, advice and clinical impression or diagnosis
- Domain C. Condition management, treatment and prevention
- Domain D. Leadership and management, education and research
In recent years there has been a noticeable shift by paramedics from their traditional employment within ambulance services into urgent and primary care roles. Many are employed directly by GP practices using in-house bespoke models of clinical supervision, support and development.
This guide published by Brooke Petter Associates Ltd aims to support general practices to understand the role of paramedics and how they can become part of a multidisciplinary team with wider skill sets, enabling new and exciting models of care to develop.
The guide outlines different models for employing paramedics within primary care, including:
- Paramedic undertakes patient home visits
- Paramedic assesses and manages patients presenting with acute illness and those with long-term conditions in same-day service clinics, including sessional work
- Paramedic conducts telephone consultations, triage and management of patients with common illnesses
Paramedics can undertake clinical roles including:
- Respond to medical emergencies within the practice.
- Take part in multidisciplinary case reviews.
- Address medicines concordance with patients / carers.
- Carry out face-to-face or telephone follow up consultations with patients.
- Signpost and refer patients to appropriate services and other healthcare professionals.
- Interpret and manage the results of blood test and x-Ray results.
Paramedics can also undertake audit and educational roles including:
- Conduct clinical audits as part of the practice multidisciplinary team.
- Implement, in conjunction with the practice team, systems such as antibiotic stewardship for monitoring medicines use.
- Contribute to the clinical education and revalidation of other healthcare professionals (e.g. Advanced, Intermediate and Basic Life Support).
- Provide input to quality improvement and practice development schemes.
Health Education England a piloting a new working model for specialist and advanced paramedics, enabling them to rotate through a variety of settings as one role – including primary care and community-based teams as well as within the ambulance service.
Paramedics have a unique skill set which enables them to deliver care to patients across a variety of settings – making them a very valuable resource, not only for the ambulance service but equally for other parts of the NHS.
It is widely acknowledged that a large proportion of 999 calls resulting in an admission to hospital by ambulance could be avoided if paramedics or community teams were able to deliver definitive patient care at the scene. The pilot aims, therefore, to send the most appropriate healthcare professional, with the appropriate skill set, to offer definitive care to a patient – the right response, first time to 999 calls, primary and urgent care contacts.
The specialist and advanced paramedics on rotation within primary care, work with one or more GP practices contributing to planned activities within the practices. This could involve ‘same day’ home visits for patients who cannot attend the surgery; seeing and treating urgent or emergency patients; concentrating on care home activity; and running clinics for selected patient groups.
Find out more at https://www.hee.nhs.uk/our-work/paramedics/rotating-paramedics.