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As the paramedic role evolves in primary care, Dr Pipin Singh explains why this group of professionals can be so valuable to PCNs.
Paramedics may be commonly associated with emergency care, but they can also add value away from the ambulance. In fact, PCNs can use paramedics’ exceptional skills to streamline and improve primary care delivery.
Many of the paramedic’s skills are valuable and relevant in primary care. For example, paramedics often undertake complex assessments requiring good history-taking skills, examination skills and interpretation of data. They can also work with undifferentiated symptoms and manage risk accordingly without a doctor’s intervention. And paramedics are accustomed to uncertainty – a critical skill in primary care.
So how can PCNs use paramedics’ expertise?
A paramedic practitioner can free GP time so that over-stretched doctors can use their skills in the most appropriate way. For example, paramedics can provide a home visiting service across a locality – one that patients can rely on and develop a relationship with. If appropriate, they could support care homes. Paramedics also provide an extra skill set within primary care teams regarding emergency care. And they can reduce PCN hospital admissions.
The use of paramedics in primary care offers many patient benefits too. These include quick access to treating minor ailments and helping patients avoid hospital admission. In addition, they may be able to spend longer with patients, providing an enhanced care experience.
The Additional roles reimbursement rcheme (ARRS) provides additional roles to PCNs to create bespoke multi-disciplinary teams – and that includes paramedics.
PCNs who want to take advantage of this scheme to recruit a paramedic need to ensure their candidate has the right skills and experience. That requires a few simple checks.
Paramedics are autonomous healthcare professionals regulated by the Health and Care Professionals Council (HCPC). Their regulatory body is the College of Paramedics. So, where a PCN employs or engages a paramedic under the ARRS, the PCN must ensure the individual is registered with HCPC.
They also need to check that their candidate is educated to degree/diploma level in Paramedicine or equivalent experience and has completed their two-year Consolidation of Learning period as a newly qualified paramedic. And they should have a further three years’ experience as a band 6 (or equivalent) paramedic.
In addition, they should be working towards developing masters-level capability in paramedic areas of practice. Within six months of taking up post – or a more extended period as agreed with the commissioner – the individual should have completed the clinical pillar competencies of the paramedic FCP/AP roadmap to practice and been formally signed off.
If the PCN’s preferred candidate cannot demonstrate they are at masters level or cannot show equivalent capability in paramedic areas of practice, such as advanced assessment diagnosis and treatment then, under the ARRS, the PCN must ensure that each paramedic is working as part of a rotational model with access to regular supervision and support from clinicians who are signed off at clinical practice masters level (or equivalent). (1)
As with hiring any team member, personal characteristics are a consideration.
For a paramedic in primary care, key traits will have been required and developed in previous paramedic roles. These include critical thinking, problem-solving, empathy, good teamwork, and excellent communication skills.
A PCN needs a paramedic with professional integrity who recognises their own limitations and knows when to ask for help. The right person would also understand reflective learning and the principles of audit. And there must be a willingness to follow up with patients as well as a commitment to learning and continuing professional development.
Paramedics possess skills that can complement those of a GP. But as there is a breadth of skills and experiences, it is essential that practices understand the competence of the paramedics within their team (see box).
Each practice may wish to use a paramedic team differently. Still, common tasks could include undertaking telephone triage, acute face-to-face consults such as lower respiratory tract infections (LRTIs), urinary tract infections (UTIs), ear infections, acute musculoskeletal (MSK) problems and more complex house visits.
The practice team should teach the paramedics how to use their particular clinical system. They should also make it clear that documentation within the notes should be timely and legible. This could be incorporated into the induction programme within the practice.
Some paramedics may not be able to prescribe, so these individuals must be given the name of someone with whom they can discuss a patient and obtain a prescription, e.g. analgesia or antibiotics. And the paramedic practitioner must have a clinical mentor or mentors with whom they can discuss cases and debrief. This is necessary for safety, ongoing reflection, and the paramedic’s professional development.
As with many of the newer roles in primary care, many paramedics coming into posts will be working in general practice for the first time. As a result, they may require more support than new recruits starting an established role, such as practice nurse or GP. So, unsurprisingly, the PCNs that put in the effort to develop the skills and organisational knowledge required of paramedics will reap the most significant benefits – and add a valuable professional to their team.
Dr Pipin Singh is a GP partner, GP trainer and training programme director in Tyne and Wear.