FOR PATIENTS
Why are paramedics working in primary care?
Across the UK, Paramedics have been an integral part of the primary care multi-professional team within general practice for many years. In EngIand, their numbers have increased in primary care since 2021 with the introduction of funding via the Network Contract Directed Enhanced Service (DES).
Many primary care providers are experiencing issues with recruiting enough General Practitioners (GPs). Whilst GPs are very important in primary care, other healthcare professionals can be beneficial to practices improving the service offered.
Paramedics are highly trained, degree-level professionals. Working in the ambulance service, they have been first responders in a variety of situations. They also see the same types of patients as GPs and are experts at keeping patients at home and linked to various community teams.
Across the UK, Paramedics have been an integral part of the primary care multi-professional team within general practice for many years. In England, their numbers have increased in primary care since 2021 with the introduction of government funding for them to be employed. Whilst GPs are very important in primary care, other healthcare professionals can be beneficial to practices improving the service offered.
What can they do?
Paramedics can be used in different ways depending on the local need for each primary care practice. GPs will still be the overall clinical lead in the primary care practice, but paramedics will be able to complete consultations for the majority of patients.
They can undertake a variety of roles including:
- Comprehensively assess, treat and manage patients of all ages with a variety of new and existing conditions.
- Paramedics are also able to mentor and supervise students from a range of health and social care backgrounds.
- Paramedics can see patients presenting with acute or urgent (same-day) problems, as well as offering pre-booked and routine appointments
- Refer to specialist services or certain investigations as appropriate.
- Request, review, and act on laboratory results
- Triage patients, carry out telephone consultations, undertake face-to-face consultations, carry out home visits (including residential and nursing homes)
The level of competence at which the paramedic in primary and urgent care can work will depend on their skills and experience, and the skills and experience of the practice team. Our case studies have some different examples of how paramedics are working in primary care.
Paramedics with the necessary qualifications who have completed the right courses will be able to prescribe medicines.
What training do they have?
The term ‘paramedic’ is a protected title by law. To practice as a paramedic, an approved degree (Bsc(Hons)) in paramedic science is required and all paramedics must be registered with the Health and Care Professions Council (HCPC). To remain on the HCPC register, registrants must demonstrate that they continue to meet these standards as this is how their fitness to practice is determined. All paramedics are required to renew their registration with the HCPC every two years, to continue to practice as a paramedic.
Most paramedics will have worked in the ambulance service prior to working primary care. Paramedics are more inclined to pursue careers in primary care when they believe that their education and prior experience in ambulance service have adequately prepared them for this transition. This prepares them well for working in primary care, as they will have had experience of managing a range of patients in many different situations.
Paramedics working in primary care may be undertaking specialist or advanced practice roles and for each of these they will have undertaken either post-graduate studies, received clinical mentoring or a combination of both. This enables the paramedic to develop a greater depth of knowledge and understanding in a range of specialist and advanced clinical skills to ensure they are well prepared to work in primary care.
What have other patients said about this?
[the paramedic’s] freeing up the doctors and to me he’s just as good as a doctor. I mean he’s a good liaison between us and the doctor, you know what I mean.
What are the benefits of paramedics working in primary care?
While the GP shortage continues to be a problem and practices look to new ways to deliver care, paramedics are increasingly used to increase workforce capacity and improve patient access to healthcare.
Clinically, Paramedics are generalists and are able to support any patients they are called out to. Those that have worked in the Ambulance Service bring a wealth of experience to their work in primary care. Consequently, they can see a broad range of practice patients.
Paramedics often have longer appointment times than GPs in primary care, which means patients don’t need to feel rushed when they are seen.
Paramedics in primary care roles often work with other healthcare professionals, such as GPs, nurses, and allied health practitioners. This team-based approach ensures that care is well-organised and comprehensive, leading to better patient results and a more complete way of providing healthcare.
The presence of paramedics in primary care settings can improve community health outcomes. They can play a vital role in health promotion, preventive care, and chronic disease management. Paramedics can provide education and support for patients in managing their health conditions, conducting home visits, and participating in community outreach programs.
What evidence is there for paramedics to work in primary care?
Research has demonstrated that paramedics are actively sought after in primary care when their knowledge and experience gained from the ambulance service are deemed valuable for the primary care workforce. When paramedics improve patient access to healthcare, their role is highly appreciated by both primary care teams and patients.
When GPs establish confidence in a paramedic’s competence, they perceive them as a valuable asset to the primary care team and actively seek their inclusion. GPs tend to favour paramedics who have had substantial experience in ambulance service, as they are seen as better equipped for primary care roles.
Paramedics’ have good ‘people’ skills and their ability to quickly build rapport and trust with patients is considered an asset in primary care. Research has found that patients are often happy to be seen by a paramedic, as long as they understood why they were not seeing a GP. Patients have reported they liked the longer consultation times.
Examples of paramedics working in primary care
Meet Matt
Meet Wesley
Meet Jack
Job title:
Community Paramedic
How long have you been a paramedic:
17 years
Where do you work:
I currently work in East Midlands, in Lincolnshire
What do you do in your role:
I’m a Community Paramedic covering 16 GP surgeries who centrally have access to a small team of us to provide same-day acute home visits and pre-planned in-house clinic support.
How do patients book in with you?
Housebound patients request home visits through their GP who then refer to us. For clinic work, appointments are made to see me directly through the GP practice.
What difference does your role make to where you work:
We offer an added level of support to the whole primary care network, giving GP practices further resources to ensure their patients are getting timely assessments by an appropriate practitioner. We pride ourselves in our flexibility that we can, as Paramedics, transition quickly from a home visiting role to a clinic-based role.
Job title:
Advanced Clinical Practitioner (Paramedic)
How long have you been a paramedic:
I have been a Paramedic for 17 years, prior to which I was an advanced technician with ambulance service for 3 years
Where do you work:
I currently work in North East England, in the Sunderland/Washington area
What do you do in your role:
As an Advanced Paramedic Practitioner within primary care, I see patients in clinic for routine and acute appointments (including home visits), and I see and treat (including prescriptions) as necessary. I undertake a weekly ward round at a care home in which I review patients for both chronic and acute health needs, and work closely with the GP lead for palliative care look after patients approaching the end of their life. I have used my experience as a paramedic to develop policies in regard to dealing with health emergencies in the clinic and worked with another paramedic in my practice to develop emergency response bags for each practice in our area.
How do patients book in with you?
Patients use a triage system called Klinik (which is similar to 111 online triage tool). When these are submitted to the practice, I review the most appropriate cases for my skill set and either book a telephone appointment or face to face consult to see them.
What difference does your role make to where you work:
I feel my role has given added value in terms of efficient triaging and management of specific patient groups who may not necessarily need an appointment with GP, but can be managed by Advanced practitioner. This enables the GP to be available to focus on patients who have more complex health needs.
Job title:
(Trainee) Advanced Paramedic Practitioner (Urgent Care).
How long have you been a paramedic:
9 years.
Where do you work:
North East London.
What do you do in your role:
As one of London Ambulance Service NHS Trust's Advanced Paramedic Practitioners in Urgent Care, my role entails working in a variety of clinical settings, which include primary care, a solo response ambulance car, an ambulance control room, and within a minor injury’s unit. I am still completing my Master’s degree, so am considered a ‘trainee’, and hope to undertake the independent prescribing module soon.
How do patients book in with you?
My patient list is made up of undifferentiated patients who book same-day appointments. This will usually be a combination of face-to-face and telephone consultations.
What difference does your role make to where you work:
Being part of a multidisciplinary team, the other allied health professionals at the practice and I act as the eyes and ears of the GP on duty, which means we are able to safely take on a much larger caseload of patients. As an autonomous clinician I am able to formulate management plans for many of my patients, however as I am still a trainee in this role, I am always under the indirect supervision of a senior GP, so the care my patients receive is in no way "watered-down" from what they will have come to expect from a traditional model of primary care.