Paramedics with Extended Skills a solution for Unscheduled Care?

As a State registered Paramedic with over 15 years experience, I have seen the Ambulance Service change from primarily a reactive transportation service with staff trained to deal with trauma and life threatening events and get patients urgently to a place of definitive care, to a service that at its core maintains the above reactive elements but has also moved to provide a service for the millions of patients that do not have an acute life threatening event, but require help.
The Taking Healthcare to the Patient Report 2005/2010 identified that only 10% of all 999 calls are for patients with an acute life threatening event, with Paramedics trained only to deal with that small 10% of patients that left a massive amount that were and are potentially transported unnecessarily to the emergency department (ED) , a recent article in the Ambulance Today magazine (Autumn 2011-Issue 1 Volume 8, p3) suggested that of all the patients transported to the ED in 2009/2010, 40% were discharged with no treatment or referral!
The Ambulance Service has developed new roles to help combat the above such as the Paramedic Practitioner which sees Paramedics being taught extended patient assessment skills at various Universities across the UK, with the aim of “taking healthcare to the patient” and providing the right response at the right time.
There are now many Paramedics trained with the essential core elements, but also practising as Paramedics with extended skills delivering what is high quality care 24/7 treating, referring and discharging patients autonomously, confidently on scene and crossing the boundaries in what was traditionally the realm of primary, secondary and tertiary care professionals.
With the current austerity measures in place and cutbacks affecting us all, practice managers, service delivery managers, GP Consortia and more importantly the public are looking at the NHS and its vast budget and they want value for money, after all it is their money that keeps us in our jobs!
The Con-Dems it seems are attempting to drive through policies that will see the NHS change beyond all recognition, into an Americanised Insurance based, Privatised model that if it is allowed to develop will see the members of our community that require an Ambulance but unfortunately cannot afford the Insurance cover getting a potentially third rate service, one that would be actually going back to a council van turning up and picking you up!
As an operational Paramedic Practitioner my approach to the patients I see has changed greatly with the new skills I am able to bring into place, using the Calgary-Cambridge model of history taking, advanced Neurological, Cardio respiratory and Abdominal patient assessment models that Doctors and Nurses use and supporting these skills with the core skills I have as a Paramedic such as Base line observations, twelve lead ECG, BM, BP, TEMP, SATS, RR, CRT, PR. The patients I and my colleagues see arguably receive excellence in clinical care and are left with a clear plan and safety net, complete with a record of our visit, a current and invaluable assessment of their cardio-vascular status that forms part of their patient records and acts as a benchmark for other Health Care Professionals.
In this increasingly expectant world we live in invariably it is 999 with requests for Ambulance calls up year on year by 12%, From 17.00 through to 09.00 with the exception of some scaled down services and the ED, patients requiring help but not suffering an acute life threatening event have a few choices they can call on, for instance the Samaritans, NHS Direct, some Minor Injuries or NHS walk in centres, GP OOH or 999.
As it is difficult to assess an emotional patient over the telephone, alcohol and the situation can “blur” the call takers interpretation leading to an escalation in the correct response the patient receives, for instance a patient having a “panic attack” is often perceived as having breathing difficulties categorised in the Ambulance Service as a Life Threatening event which requires an eight minute response So on this one incident a Double Manned traditional Ambulance would be mobilised along with a single manned Paramedic Practitioner in a car in order to hit the target but also provide the best possible clinical care.
Once on scene the Paramedic Practitioner would have assessed the patient, stood the crew down and then deal with the situation. This model of service delivery is high cost, and high risk with two Ambulances travelling at high speed through traffic putting themselves and the public at increased risk, it is the ultimate in delivering patient care and reassurance to an expectant population but in this current climate does not provide cost effectiveness.
I for one believe Paramedics with extended skills can compliment and prove to be an asset to GP Practices and compliment existing services, leading to a more enhanced service and reassured customer base.
With Ambulance Services currently being measured on response times the PP role is unlikely to get the chance of developing unless a change in current service delivery is realised.
That said I suppose the point of my posting would be to ask all you GPs out there would the PP role be something that you could see complimenting your practice?