Article Figures & Data
Figures
- Figure 1. Overall view of paramedics working in general practice.
Missing data n = 25.
Tables
Search strategy and terms ’GP*‘ OR ’general practitioner*‘ OR ’family practitioner*‘ OR ’family physician*‘ OR ’family doctor*‘ OR ’primary care‘ OR ’primary healthcare‘ OR ’primary health care‘ OR ’primary practice*‘ OR ’general practice*‘ OR ’family practice*’AND ‘paramedic*’ OR ’emergency care practitioner*‘ OR ’urgent care practitioner*’Limited to English.Databases: Medline, Cochrane, EMBASE, Psych INFO, AMED, CINHAL plus Records identified Records excluded at title and abstract screening, n = 3017Full texts for screening, n = 29Full texts for screening after duplicates removed, n = 17 (12 duplicates found)Full texts screened for relevance after reading articles, n = 14 Literature review summary (n = 14) Year Author Title Publication Summary 2005 Ball L11 Setting the scene for the paramedic in primary care: a review of the literature Emergency Medicine Journal Explores the published evidence that surrounds paramedic practice in an attempt to identify the skills, training, and professional capacity that paramedics of the future will require. Identified the paucity of published evidence. Concluded that paramedics must work together to take ownership of the basic philosophies of their practice, which must have their foundation in valid and reliable research. 2012 Daly J12 The paramedic in the community: my story Primary Health Care Aims to provide a clear picture of the role of paramedics based in the community and show how this role has developed through the pioneering personal experiences of a paramedic working in a medical practice. It highlights, through the responses to a questionnaire, how paramedics could be an effective additional resource to an established primary care team. 2018 Eaton G,Mahtani K,Catterall M13 The evolving role of paramedics — a NICE problem to have? Journal of Health Services Research and Policy Supports the growing role of paramedics in the clinical and academic workforce. A commentary on recent draft consultations by the National Institute for Health and Care Excellence (NICE) in England that set out how the role of paramedics may be evolving to assist with the changing demands on the clinical workforce and suggest that the profession should also lead the academically driven evaluation of these new roles. 2014 Evans R,McGovern R,Birch J,Newbury-Birch D14 Which extended paramedic skills are making an impact in emergency care and can be related to the UK paramedic system? A systematic review of the literature Emergency Medicine Journal A total of 8724 articles were identified, of which 19 met the inclusion criteria. Fourteen articles considered paramedic patient assessment and management skills, two articles considered paramedic safeguarding skills, two health education and learning sharing, and one health information. There is valuable evidence for paramedics assessing and managing patients autonomously to reduce emergency department conveyance, which is acceptable to patients and carers. Evidence for other paramedic skills is less robust, reflecting a difficulty with rigorous research in pre-hospital emergency care. 2018 Mahtani KR,Eaton G,Catterall M, Ridley A4 Setting the scene for paramedics in general practice: what can we expect Journal of the Royal Society of Medicine Current opportunities for employment in NHS general practices still require careful evaluation for context-specific clinical outcomes, value, and satisfaction. 1974 Marsh GN,McNay RA15 Team work load in an English general practice British Medical Journal A survey of a general practice demonstrated that by delegating work to a team of paramedical workers, by increasing the proportion of personal medicine, and by engaging the cooperation of patients the GP reduced his workload considerably without any apparent reduction in standard of care. 2009 Martin-Misener R,Downe-Wamboldt B,Cain E, Girouard M16 Cost effectiveness and outcomes of a nurse practitioner-paramedic-family physician model of care: the Long and Brier Islands study Primary Health Care Research and Development The study in a rural Canadian setting evaluated nurse practitioners, paramedics, and family physicians providing care together. This model of care resulted in decreased cost, increased access, and a high level of acceptance and satisfaction among care providers. 2018 Moule P et al 7 Preparing non-medical clinicians to deliver GP out-of-hours services: lessons learned from an innovative approach Education for Primary Care This article presents the development and evaluation of one programme delivered in 2017 to paramedics seeking to work in out-of-hours (OOHs) services. The findings suggest the course was able to provide the students with the skills, knowledge, and confidence to become safe practitioners in the OOHs service. 2019 Rasku T et al 9 The core components of community paramedicine — integrated care in primary care setting: a scoping review Scandinavian Journal of Caring Sciences The Community Paramedicine programmes are perceived to be promising. However, Community Paramedicine research data are lacking. Further research is required to understand whether this novel model of health care is reducing costs, improving health, and enhancing people's experiences. 1983 SaintYves IF17 The training of paramedics for primary health care Journal of the Royal Society of Health Defends the use of appropriately trained paramedics as first point of contact in the primary care setting to alleviate staff shortages. 2017 Spence D5 Good medicine — the GP paramedic British Journal of General Practice A one-page personal commentary from a GP in Glasgow supporting the role of paramedics in GP settings and proposing the name changes to GP doctor, GP nurse, and GP paramedic to allow for the changes to the healthcare team. 1974 Willemain TR,Moore GT18 Planning a medical practice using paramedical personnel Health Services Research Using a mathematical model the paper sets out a planning methodology to decide on the trade-offs between key parameters in terms of type of paramedic, size of practice, costs, and so on to help determine the impact of the use of paramedics in primary care. 2006 Woollard M8 The role of the paramedic practitioner in the UK Journal of Emergency Primary Health Care Describes the evolution of the role of the paramedic practitioner in the community and the formalisation of the training needs for paramedics to work autonomously in the community setting. 2016 Schadewaldt V,McInnes E, Hiller J, Gardner E19 Experiences of nurse practitioners and medical practitioners working in collaborative practice models in primary healthcare in Australia — a multiple case study using mixed methods BMC Family Practice This study investigated the experiences and perceptions of nurse practitioners and medical practitioners who worked together in Australia and found that the willingness of practitioners and their individual relationships partially overcame the effect of system restrictions. However, this article highlights the need for strategic support to ensure the sustainability of collaborative practice models in primary health care. Model of employment n % Directly employed by GP practice 98 59.4 Directly employed by CCG 2 1.2 Contract with community provider 2 1.2 Freelance or locum contract 0 0.0 Agency 0 0.0 Contract with local ambulance trust 14 8.5 Other 8 4.8 PCN 6 3.6 Combination of GP practice and PCN 10 6.1 Other combination 16 9.7 Missing 9 5.5 Total 165 Tasks undertaken a Same-day home visits 145 91.8 Routine home visits 97 61.4 Same-day clinic 118 74.7 Pre-booked clinic 53 33.5 Same-day telephone triage 56 35.4 Pre-booked telephone triage 21 13.3 Telephone triage 68 43.0 Web triage 8 5.1 Other tasks 22 13.9 Total 588 Exclusions reported b No exclusions 27 24.1 Aged <6 months 25 22.3 Aged <1 year 23 20.5 Aged <2 years 12 10.7 Aged <5 years 5 4.5 Pregnant women 22 19.6 Sexual health or gynaecology 17 15.2 Mental health 20 17.9 End of life or palliative care 14 12.5 Chronic or complex conditions 14 12.5 Other specified conditionc 12 10.7 Totald 164 aDenominator 158; 7 responders did not answer/didn’t know. bDenominator 112; 53 responders did not answer/didn’t know. cFor example, moles, lumps, patients in care homes, and decision made by paramedic. dSome responders reported more than one exclusion. CCG = care commissioning group. PCN = primary care network.
KI meetings Sex Role Employer KI 1 Male GP CCG KI 2 Female GP CCG KI 3 Female Commissioner CCG KI 4 Male GP CCG KI 5 Male Paramedic CCG KI 6 Female Commissioner CCG KI 7 Male Paramedic CCG KI 8 Female Paramedic Professional body KI 9 Female Paramedic NHS SH interviews SH 1 Female Paramedic SH 2 Female GP SH 3 Female Practice manager SH 4 Female GP SH 5 Male GP SH 6 Male GP SH 7 Male Practice manager SH 8 Female Practice manager SH 9 Female Paramedic SH 10 Female GP CCG = clinical commissioning group. KI = key informant. SH = stakeholder.
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Exploring how paramedics are deployed in general practice and the perceived benefits and drawbacks: a mixed-methods scoping study
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