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The role of paramedics is evolving. They still answer emergency calls, but they can also become part of primary care teams at GP practices or first-aid units. New research found that clear role descriptions and good communication are needed for paramedics to be effectively integrated into primary care teams.

National policies are encouraging paramedics to move to primary care. Potential benefits could include freeing up GPs’ and nurses’ time. In addition, many paramedics find they like working in primary care teams as the hours give them a better work/life balance. However, there is a lack of guidance to help paramedics make the change.

Now, researchers have analysed 205 documents on the role of paramedics in primary care. They were looking for practices that help paramedics integrate into the primary care team and make the transition as smooth as possible.

Clear roles and boundaries avoided task duplication and reduced mistrust with other primary care team members. Good communication with patients helped them understand why and when they might see a paramedic (rather than a GP or nurse) at their practice.

Supervision by GPs helped paramedics make the transition into primary care. Even so, paramedics could reduce GPs’ workload when they were treated as clinicians, able to manage their own patients.

What’s the issue?

Paramedics traditionally provide emergency care and respond to emergency 999 calls through their work in the ambulance service.

Recent changes in the way people access healthcare mean that only 1 in 12 (8%) emergency calls are now for life-threatening illnesses or injuries. Many people call 999 for other reasons, such as minor injuries or illnesses, acute mental ill health episodes, or social care needs. To meet this demand, paramedics have become skilled in other areas beyond emergency care.

In the UK, paramedics require degree-level education. They can take further courses to progress to more advanced and more general roles. Paramedics have been working in primary care (for instance at GP surgeries and first-aid units) and urgent treatment centres since 2002.

Primary care has experienced more demands on services and is caring for more people with complex needs in the community. Recruiting and retaining staff is a challenge, and primary care teams need other clinicians to work alongside them. For paramedics who want to work within daytime hours, this could be an attractive prospect and a natural evolution of their role.

In countries such as the US, Canada, and Australia, paramedics travel to different areas to provide primary care. In this way, they can expand the reach of health services to under-served populations, including those in remote locations, or who have difficulty travelling.

The researchers wanted to identify practices that help paramedics integrate effectively into the primary care team.

What’s new?

Researchers looked at 205 documents covering the role of paramedics in primary care. This included research papers, policy documents and case studies from systems with a well-established role for paramedics: in the UK, Australasia, Canada and the Americas.

The team explored the expectations of patients, GPs and paramedics. They looked at paramedics’ transition into primary care, and their integration within the team.

Expectations of paramedics

  • Patients were happy to be seen by a paramedic, as long as they understood why they were not seeing a GP. They liked the longer consultation times. Posters on practice noticeboards were an effective way of informing them about paramedics in primary care.
  • GPs who thought paramedics needed clinical oversight experienced an increased workload. Those who saw paramedics as autonomous clinicians (who could diagnose and manage their own patients) saved time and had reduced workloads.
  • Paramedics saw working in primary care as an opportunity to develop their skillset in a structured, supportive environment. Many felt that working during office hours would improve their work/life balance. Paramedics saw themselves as clinicians who can deal with any complaint.
  • Contribution to primary care teams was greatest where paramedics had generalist knowledge and could deal with a wide range of issues. Paramedics could increase access to healthcare in rural communities, for example, by running first-contact centres closer to where people lived.

Transition from emergency services into primary care

  • Formal education was needed for paramedics to be fully effective in primary care. This included biochemistry (for interpreting blood work and managing multiple conditions) and pharmacotherapy (how drugs work).
  • Supervision to support paramedics’ clinical development helped make their transition into primary care successful. GPs who supervised paramedics helped build relationships and acceptance by the primary care team. Paramedics were less satisfied if they had no supervision or a difficult relationship with their supervisor.
  • Five years’ experience as a paramedic was generally needed before the move into primary care.

Paramedics' interpersonal skills and their ability to quickly build rapport and trust with patients was an asset in primary care. They needed clearly defined role boundaries to prevent them duplicating other staff members' responsibilities, and to help them integrate into the primary care team.

Why is this important?

The researchers made recommendations that they hope will help paramedics to make the best use of their skills and to feel welcomed by primary care teams.

These include:

  • clear communication with patients from a trusted source about the paramedic’s role in primary care
  • full integration within the primary care team workforce
  • clarity of the boundaries of primary care team roles, which avoids duplication and frustration
  • support including formal education and clinical supervision
  • awareness of paramedics’ skills including their ability to build rapport with patients quickly, their adaptability, and that they know when to ask for help.

The researchers concluded that paramedics who are well integrated into the primary care team can expand their skillset and improve their work/life balance. They can also reduce the workload of GPs and other members of the primary care team.

What’s next?

Including paramedics in primary care teams is part of the NHS long-term plan. But guidance about how paramedics make the move into primary care is still lacking. The researchers hope that their research will form the basis of recommendations and guidance.

More work is needed to explore what happens to the professional identity of paramedics who move to primary care. The research team would also like to look at whether people with acute problems or minor injuries (as opposed to those with long-term conditions) might be best served by paramedics in primary care.

You may be interested to read

This NIHR Alert is based on: Eaton G, and others. Understanding the role of the paramedic in primary care: a realist review. BMC Medicine 2021;19:145

Paramedic Specialist in Primary and Urgent Care Core Capabilities Framework: a framework from the College of Paramedics about the role of the paramedic in primary care.

Previous analysis of paramedic roles in primary care by the same research team: Eaton G, and others. Contribution of paramedics in primary and urgent care: a systematic review. British Journal of General Practice 2020;70:E421–6

First Contact Practitioners and Advanced Practitioners in Primary Care: (Paramedics) A Roadmap to Practice - a paper from Health Education England on the transition to primary care for paramedics.

 

Funding: G Eaton is supported by an NIHR Doctoral Research Fellowship. KR Mahtani, G Wong, S Tierney and N Roberts are supported by the NIHR School for Primary Care Research Evidence Synthesis Working Group.

Conflicts of Interest: The study authors declare no conflicts of interest.

Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.


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Commentaries

Study author

Paramedics are included in primary care teams in several countries. But there’s a lack of understanding about how the roles work and how they contribute to the primary care teams. In the UK especially, there are so many demands on GPs’ time, and paramedics might reduce this.Health Education England has produced a framework outlining education and training (a roadmap) for first-contact practitioners. This covers paramedics in primary care roles. The problem is that it is not documented how paramedics should make the transition from the ambulance service, as their traditional employer, into primary care.Our work describes some clear best practices that we hope primary care teams will use. The end goal will be to draft national guidance to make sure everyone is doing things in the most optimal way.Georgette Eaton, NIHR Doctoral Research Fellow, University of Oxford 

College of Paramedics 

With increasing numbers of paramedics exploring available career options in primary care, it is important that transitioning into these roles is well-planned and supported.This study will help primary care employers understand how best to facilitate this and integrate paramedics within their teams.Helen Beaumont-Waters, Head of Clinical Development for Primary and Urgent Care at the College of Paramedics 

Member of the public 

The article provides background to a story hidden from public view. To read that there is a clinical and public benefit for paramedics to be attached to primary care is an eye opener. It is hard to see how it works in my small market town. It suggests that paramedics need to become familiar with the local population and geography, and with primary care staff, to create a sense of teamwork that has not historically existed. This is puzzling. I doubt I am alone in thinking that paramedics are pretty well trusted as it is, and I suspect primary care staff trust them even more than patients do.If changes to existing practice are to be formalised, there needs to be discussion about evolving roles.The impact will be less on patients and more on budgets, and on supervision. Are paramedics to be overseen by primary care rather than the ambulance service? Or should ambulance service management retain responsibility even if primary care is supervising? Members of the public can have a valuable role in examining dispassionately the pros and cons.Jeremy Dearling, Public Contributor, Norfolk 

Paramedic

The paper provides greater understanding of the paramedic’s role within primary care and also provides useful advice as to how paramedics can integrate with the primary care team. This research is a huge positive step towards better healthcare services for the public where being able to have open conversations is key to patients receiving optimised care through the development and maximisation of integrated professional roles. The paper supports the development of the paramedic role, and the facilitation of primary care at a time when this is more important than ever.Craig Mortimer, Paramedic Researcher Manager, South East Coast Ambulance Service NHS Foundation Trust: Kent, Surrey, Sussex 

Paramedic

This paper informs the direction of travel of the paramedic profession into primary care. It identifies the factors that impact on integration of the paramedic into primary care and how these factors can be addressed to the benefit of all.It is likely to guide future developments related to the role of paramedics working in primary care, including health policy, education and training. It should encourage closer working between primary care providers and paramedic organisations.” Vince Clarke, Paramedic Principal Lecturer and Programme Leader BSc (Hons) Paramedic Science, University of Hertfordshire 
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