Patient and carer perceptions and advice on the integration of paramedics into the GP practice workforce

Greehy, Cath*; Cooper, Carolyn*; Hayman, Deborah*; Khan, Hameed*; Mandunya, Richard*; Mcaulay, Mel*; Palma, Francesco*; Smith, Deb*; Tomline, Ann*; Eaton, Georgette**

 *Patient and public group representatives, NIHR300681.

**Georgette Eaton (corresponding author)is an NIHR Doctoral Research Fellow, Nuffield Department of Primary Care Health Sciences, University of Oxford. She is on twitter: @georgette.eaton

Paramedics are traditionally associated with responding to life-threatening emergencies within the ambulance service. However, paramedics are now increasingly found in primary care settings across the United Kingdom(UK).¹ Whilst efforts are being made to explore² and understand³ the paramedic role within primary care, what is often missing from research and policy informing practice is the voice of patients.

As a patient and public group associated with a National Institute for Health Research (NIHR) career development award (NIHR300681), we want to rectify this and offer practical advice for primary care practices to consider as they implement paramedics in their workforce.

Here, we set out some of the information that we think can be used as a practical guide for primary care settings who employ paramedics to provide care to their patients:

We now have paramedics working in our surgery…

Introduce the paramedic to us! We would like to know their level of training and experience, to reassure us that they’re safe to work in primary care and help us join the dots regarding how they might impact us. The fact that paramedics undertake further education to work in primary care is reassuring,⁴ and it is something that we feel is important patients and members of the public know to help build us trusting relationships with them as they provide our care.

As part of this, it would be useful to know how we will recognise them. Will they wear green uniform? Or will they have a name badge, or a different coloured lanyard? It’s important to us that we know who we’re talking to when we see a clinician, and visual clues can be useful to help with this. As well as this, clearly outlining the clinical background at the start of a consultation, or when one is being booked, helps ensure we know who we’re talking to.

What role they will be undertaking?

We’re interested in the type of work paramedics will do, and when we might see them. Will they be part of telephone triage? Will they offer video or face-to-face consultations? Will they undertake home visits? Or could my routine review appointment be with them? Lastly, if I see a paramedic – will they leave the consultation part way through due to attending a 999 call?

Setting expectations by outlining the role the paramedic will undertake is also useful. Can they undertake all examinations? Can they prescribe us medicines if needed? If we need to see a specialist (for example, if we’re worried about cancer), will the paramedic be able to refer us? Is there anything that the paramedic can’t do, that we should see a General Practitioner for?

From a practical perspective, understanding the hours the paramedic works (whether they are full time, or part-time, or work on certain days) is also helpful, so we know what we can expect on particular days when we may have contact with the practice.

Reassurance that our medical needs will be met if we see a paramedic is helpful to build trust.

Engaging with the community

Communication needs a combination of methods to reach the range of patients registered within the practice. Receptionists are crucial to this, as they are the front door of primary care, and we trust them to book us in with the most appropriate professional.

Other community engagement may include:

• Biographies about staff members are not always useful, but a staff noticeboard (physical or virtual) that answers questions posed here is good place to help set expectations.
• Community groups associated with the practice that already exist, such as the Patient Participation Group (PPG), who can cascade information in leaflets or local magazines/newsletters.
• Practice website – perhaps through the PPG or a blog – especially if booking can be done online.
• Social media (eg. Facebook group page or Twitter channels)

Conclusions 

With increasing demands compromising the time available to General Practitioners within the primary care workforce, we appreciate that new clinical roles, such as paramedics, are moving into primary care to boost the services available to patients. Primary care providers should be aware of the perceptions patients and members of the public have of paramedics, and so should consider strategies to communicate their employment of paramedics to patients registered with them. This will help ensure patients understand, and accept, why they may be seeing a paramedic instead of a General Practitioner.

References

1. Eaton G, Wong G, Williams V, Roberts N, Mahtani KR. Contribution of paramedics in primary and urgent care: A systematic review [Internet]. Vol. 70, British Journal of General Practice. British Journal of General Practice 2020; 70 (695): e421-e426. DOI: 10.3399/bjgp20X709877
2. Schofield B, Voss S, Proctor A, Benger J, Coates D, Kirby K, et al. Exploring how paramedics are deployed in general practice and the perceived benefits and drawbacks: a mixed-methods scoping study. BJGP Open. 2020;bjgpopen20X101037.
3. Eaton G, Wong G, Tierney S, Roberts N, Williams V, Mahtani KR. Understanding the role of the paramedic in primary care: a realist review. BMC Med 19, 145 (2021). https://doi.org/10.1186/s12916-021-02019-z
4. Health Education England. First Contact Practitioners and Advanced Practitioners in Primary Care : (Musculoskeletal) A Roadmap to Practice. London, England; 2021. https://www.hee.nhs.uk/sites/default/files/documents/Paramedics-FINAL%20(002).pdf

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