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How to… work with a paramedic



GP partner and PCN co-lead Dr David Coleman outlines what paramedics can bring to general practice and how to decide if the role would suit your network

A paramedic can be a highly valuable addition to the primary care team. Paramedics can now train as independent prescribers, and with our ambulance services under immense pressure there are likely to be many paramedics considering a career change.

Under the Additional Roles Reimbursement Scheme (ARRS), PCNs are now guaranteed 100% reimbursement for the costs of employing a paramedic including a salary at Band 7 – or at Band 8A for an advanced practitioner – on the NHS Agenda for Change pay scales.1

Here are tips based on my experience of employing a paramedic, on how the role can support general practice and what to consider before hiring.

Think beyond acute presentations

Paramedics can primarily offer support with assessing patients with acute symptoms, but they can develop wider clinical expertise and also become involved in audit, education and even management. 

The ability to assess and manage emergencies makes paramedics ideally suited to undertaking home visits in the community. Their experience and communication skills also mean they can handle challenging discussions about future wishes, including attitudes towards resuscitation and end-of-life care. With experience and the support of a multidisciplinary team (MDT), paramedics can contribute to anticipatory care, care home ward rounds and even learning disability care as part of a small team of clinicians.

Indeed, the requirements of the ARRS stipulate that as well as managing acute presentations, a PCN paramedic must work as part of its MDT, support delivery of anticipatory care plans and lead certain community services.1

Decide on your PCN’s priorities

Think about how a paramedic will fit into the wider MDT. For example, if you base the role in a small number of practices with a particular need, such as a high visiting caseload, consider how the role will be shared out equally. 

The ARRS allows for a rotational system with the local ambulance trust, and PCNs should co-operate with the trust to ensure a sustainable workforce. Direct employment by the PCN would be preferable in my view, to allow the role and relationships with the MDT and wider ARRS team to develop. However, the support of an ambulance service, for supervision and host employment, may be an attractive option for some PCNs.

Consider the benefits to your wider team

A paramedic can bring a unique perspective to practice clinical meetings and significant event analysis, particularly if the case has an acute care aspect. A paramedic may also be a qualified CPR instructor. The role can provide a welcome degree of flexibility as well – for example, where GPs are struggling to manage the volume of home visits, paramedics can pick up the slack.

Make it a long-term investment

Most practices could benefit from an experienced paramedic. The key is having the capacity to provide the right level of supervision, particularly in the first 12 months. Build in time for regular progress review meetings in the first six months and make sure the paramedic can attend appropriate GP registrar tutorials and clinical meetings. If you recruit a non-prescribing paramedic, you will need a system for prescription management. An on-call doctor – allowing a paramedic to discuss a case and obtain the script – prevents delays in prescribing.

Factor in equipment and space

You may need to provide additional resources for the role, including equipment and a room. We provide our paramedic with a doctor’s bag of basic kit, but she drives her own vehicle and has car insurance that covers business use. We also have plenty of room space, but this is something more spatially constrained practices or PCNs should bear in mind.

Keep patients informed

Patients are generally very happy to see a paramedic, particularly if they have an acute problem. The key is transparency. We make it clear over the phone that they will be seeing an experienced paramedic practitioner.

As with any new additional enhanced skills role, explain to patients the rationale for employing a paramedic. A video in the waiting room, an article in the practice newsletter or a presentation to the patient participation group are all good ways of doing this. You might even consider referring to staff as, for example, the ‘GP doctor’, ‘GP nurse’ and ‘GP paramedic’, with all primary care clinical staff wearing scrubs.2 We haven’t gone as far as that, but it is one approach to consider.

Dr David Coleman is a GP partner and PCN co-clinical director in South Yorkshire

For more articles on staffing, visit pulse-intelligence.co.uk 

References 

  1. NHS England. Network Contract DES. Contract Specification 2021/22 – PCN requirements and entitlements
  2. Spence D. Bad Medicine: Good Medicine – The GP Paramedic. Br J Gen Pract 2017;67:314

READERS' COMMENTS [6]

Michael Mullineux 19 August, 2021 3:29 pm

Not convinced, sorry. Whilst paramedics may well be a ‘valuable addition to the primary care team’, removing them from potential key front line first response services to perform routine home visits and MDT meetings in the midst of a staffing crisis is like robbing Peter to pay Paul

Patrufini Duffy 14 September, 2021 8:00 pm

I’d rather work with a paramedic via 999. Seems more valuable than triaging a migraine or panic attack after line of cocaine. But, they probably see the same dross out there too, looking for the lost cat at 2am.

Dave Haddock 17 October, 2021 9:25 pm

Sadly many networks are run by people inept enough to attempt to inflict paramedics on Practices that have no use for them.

Whether or not a Practice uses paramedics needs to be decided by those running the Practice.

Hot Felon 4 November, 2021 3:23 pm

A conversion course and some emergency experience.
Another cheap Noctor.

Dave Haddock 9 November, 2021 6:41 pm

Sadly our allocation are inadequately knowledgeable to be either useful or safe seeing acute patients in surgery, and the patients don’t want to see them.
It might be possible to inflict them on the public in heavily deprived areas where patients often fail to distinguish competent from incompetent practice, and lack both choice and voice even if they do. Or perhaps they may find a niche in routine screening.
Letting them loose on patients unwell enough to attend looks highly risky.

Dave Haddock 16 November, 2021 7:34 pm

Ambulance service is apparently in crisis.

Meanwhile back at the surgery, ambulance trained paramedics are being paid to sit about because patients don’t want to see them and there is no useful work for them to do.

Classic NHS.