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How employing a paramedic solved our recruitment problem

When Dr Jonathan Cope’s practice failed to recruit new staff to conventional roles, it employed a paramedic to help with triage and patient assessment

Like many practices around the country, we were short-staffed and had no applications for jobs we advertised. So we decided that our practice - a partnership of three merged practices in south Devon serving 33,000 patients - needed an alternative solution to keep it afloat.

What we did

I first met our paramedic, Simon, when he came to the practice to update me on one of my frail elderly patients to whom he had been called out. He had done an excellent job and I kept his contact details.

When our practice decided to look for other skills to fill the gaps we had, I thought of Simon. He was surprised when we proposed he join our team, but keen to explore the idea. After meeting the other GPs, who were equally impressed with him, he started working for us in May on the equivalent of an AfC Band 8 pay grade.

He works alongside a nurse practitioner and a pharmacist as part of a rapid assessment team dealing with on-the-day urgent appointments.

Receptionists triage calls for same-day appointments to the members of the rapid assessment team, trying to match callers to the team member with a skill set most suited to their complaint.

Simon works from 8am until 6pm. His first hour is spent calling back patients who have asked to be seen that day, offering advice over the phone or inviting patients in for face-to-face appointments if necessary. He deals with presentations such as chest pain, palpitations, pneumonia and infections in children, as he is used to dealing with emergency health issues.

He also does roughly two home visits a day; his paramedic background means he is confident going into people’s houses and looking at environmental factors that might be contributing to their illnesses.

If you hire a paramedic you are offering them another avenue for professional development and the opportunity to learn more clinical skills. Simon has protected time for educational support, which he wouldn’t get with the ambulance trust, and a working life compatible with having a young family, instead of night shifts.

Challenges

One barrier for the practice was that Simon was hard to insure. The Medical and Dental Defence Union of Scotland will recognise the nurse practitioner role, but not the role of paramedic, so we had to have separate indemnity for him. Also, Simon can’t prescribe until paramedics are recognised as a professional group, which we hope will happen some time next year. In the meantime, he has to run prescriptions past one of the GPs.

Benefits

The practice hasn’t had any negative feedback from patients - indeed, they have started to ask specifically to be seen by Simon for ‘urgent’ problems.

He has brought new skills in triage, minor injury and patient assessment. He has also provided training in resuscitation and catheter changing, which we previously had to buy in.

All in all, our rapid assessment team takes a huge amount of pressure off the duty doctor. GPs have seen in two months a 30-40% reduction in calls and home visits. Being on duty used to be something you would dread and it could be a very long day. Now, although it’s still busy, it is manageable.

Hiring a paramedic is worth serious consideration, especially for larger practices or those in more rural areas.

Dr Jonathan Cope is a GP in Ivybridge and managing partner at the Beacon Medical Group in South Devon

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Readers' comments (22)

  • Well done for thinking outside the box. This rising demand has to be addressed somehow and if we are unable to educate our staff and patients then I guess that is the next best thing.

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  • This is an innovative step, however, in our area, the ambulance trust are struggling to recruit paramedics and are already carrying a lot of vacancies. Maybe robbing Peter to pay Paul?

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  • Jeannie Bee: Not sure this is robbing Peter to pay Paul, I am a paramedic that works in GP and having worked 20 years in frontline work it has allowed me to diversify rather than burn out. An infinitely better proposition than leaving and never seeing a patient in the NHS again. My profession is diversifying and I am fortunate that your colleagues have the foresight to recognise that I have a skill set that is unique and make me feel a valued and high performing part of a team.

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  • I have always maintained that about 70 % of home visits are inappropriate due to various factors and wasting valuable time that could be spent in the surgery seeing more patients.
    Following a training paramedic attachment to my practice last year, who proved to be excellent, I suggested that we should employ him permanently. As funding was an issue we could employ him only for 2 days a week. Those 2 days are just "bliss" as he does all the visits from 10am to 6pm which frees the doctors from having to rush around visiting the acutely and chronically ill. He does all the routine assessments for the elderly, mental health and memory assessments for those who are housebound and in rest or nursing homes. This means the doctors are able to conduct the consultations in a relaxed manner and all the admin chores are completed effectively.
    We are now looking for paramedics for the other 3 days. The only stumbling block is that the ambulance service are not happy about losing them to general practice and imposing some strict contracts which can result in the paramedics paying back the ambulance service thousands of pounds for the training they had.

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  • This is business management sold nicely! Many ????
    What about hiring medium as risk assessment tool?

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  • What's the deal here with everyone and their dog being able to prescribe?

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  • It's not a bad solution to the current problem.

    But the real problem here is not lack of man power, but rather abuse of system by the public. Just yesterday, had a complaint I will not visit a 86 years old as he is capable of going abroad for holiday and attends local dentist. I'm told by the family my action is disgusting as their father should not have to go out of the house at his age.

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  • Well, I'm pleased for you

    But this is nothing but a short term sticking plaster for a terminal problem.

    And as a young GP I'm afraid you have many more years of abuse to come

    A paramedic or emigrate? I'd do the latter

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  • We should have people like Simon in every surgery.Paramedics do a fantastic job.
    We should be training more paramedics.

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  • Samuel Lewis

    remember 'John Wayne' survival advice --

    GPs gotta do what a GP gotta do..

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  • If GP's/CCG's invested in training more nurses to do their MSc and prescribing modules then there wouldn't be a need to divert paramedics from the role they were trained to fulfill.
    I have now completed my MSc (at entirely my own expense) and work as a prescribing ANP in a large GP practice running their same day service. Locum GP's come in and refuse to work on duty day clinics as they find the pace too stressfull.
    I know several nurses keen to take on the advanced training but haven't got the £10,000+ to do so.
    With the GP recruitment crisis we are in there needs to be some longer term planning instead of reactive decision making.

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  • Would I employ a paramedic in our Practice ......NO!

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  • How pleasing to see a surgery seeing the benefits a "paramedic" can offer. As a recently retired at 58 and 34 years service, the last 8 years as an Emergency Care Practitioner/ paramedic specialist- primary care. Prescribed under a PGD, sutured, catheterised, wound care etc and worked as part of the out of hours service. But due to an injury unable to work on front line duties my trust has no position for me so I have retired but would be more than capable of assisting in a surgery,as would many of my colleagues. I believe we all have our place in the vastness of the NHS even for GPs in the Ambulance services !

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  • Hi I'm the Paramedic practitioner in this article. Para medicine is evolving and paramedics are providing high quality patient care in many areas. Paramedics in primary care is not a new concept. As an Emergency Care Practitioner in my former career I would treat over 90% of patients on scene or refer onto other community care services rather than sending them to the ED. I've worked in the military, private sector and as a lecturer at a university teaching clinical skills to an array of health care professionals. Beacon medical group is a contemporary patient focused general practice and saw the potential of having an advanced paramedic within its practice. So far the statistics show the experiment is working. Every day is a learning day and I am very much enjoying the experience working with high caliber individuals.

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  • In Bangladesh paramedica are working in hospitals specially in rural areas. They are assessing emergencies & reffering them accordingly to us(Doctor). But after serving a longer duration they are thinking that they can serve like a doctor. Even some corrupted specialists are abusing them as because they are serving for cheap costs. I hope Britain will not suffer like this by appointing paramedics.

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  • Paramedics may be appropriate for a medium to large practice with a high visit rate. They cannot replace a GP in a smaller practice which is having difficulty in recruiting a GP.

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  • As a paramedic with over 20 years experience, I would welcome the opportunity to work in primary care. I feel that paramedics could bring a lot to this setting as well as broaden their own horizons. We are undervalued by many healthcare professionals, so maybe we should be given the chance to show what we're capable of. We are skilled in comprehensive history taking, thorough examination and formulating treatment plans, referring patient down appropriate care pathways where necessary.

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  • Hi Simon - thanks for coming out as the PP in the article. When I read it I was surprised to see the description simply as "paramedic" and not "paramedic practitioner" - a whole extra skill set.

    I think paramedic practitioners are well suited to GPland - we use them lots in the South Coast - but I don't think a non-practitioner paramedic would cope in the role so well due to the training and scope of what they are used to doing.

    Was the loss of the word "practitioner" in the article a slip in editing or do your employers not realise the difference?

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  • 9.30pm.... You state that you think 70% of home visit requests are inappropriate. Then explain that employing a paramedic has made life better as they now do the visits. I'm not sure this makes any sense.... Surely the visit requests are still inappropriate, and hence should be declined??

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  • Simon Robinson.... My husband (advanced paramedic with HART) is interested in joining general practice. He wondered what additional training was needed? Ecp?

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