How are paramedics deployed in general practice and what are the perceived benefits and drawbacks? A mixed methods scoping study
General Practice in the United Kingdom faces continuing challenges to balance a workforce shortage against rising demand. The NHS England General Practice (GP) Forward View proposes development of the multi-disciplinary, integrated primary care workforce to support front-line service delivery, including the employment of paramedics. However, very little is known about the safety, clinical or cost effectiveness of paramedics working in general practice. Research is needed to understand the potential benefits and drawbacks of this model of workforce organisation. The aim of this study is to understand how paramedics are deployed in general practice, and to investigate the theories and drivers that underpin this service development.
This was a mixed methods study using a literature review, national survey and qualitative interviews. The study was conducted in three phases: 1) A mapping exercise which involved a systematically search scoping review of the literature review and web-based survey of paramedics, and staff working with them, in general practice. 2) Meetings with Key Informants to locate existing theories about the intended outcomes of deploying paramedics in general practice. 3) Semi-structured qualitative interviews with stakeholders to examine the underlying assumptions about how different approaches to paramedic deployment are intended to work.
There is very little evidence on the safety and cost effectiveness of paramedics working in general practice. The findings from this study indicate significant variation in the types of models adopted and disparity in a number of areas. The majority of models reported include home visits as a key feature. However, the type of patients seen and conditions treated vary significantly. Nonetheless, there is a largely positive view of this development and a perceived reduction in GP workload. However, some concerns centre on the time needed from GPs to train and supervise paramedic staff.
The contribution of paramedics in general practice has not been fully evaluated. There is a need for research that takes account of the substantial variation between service models to fully understand the benefits and consequences for patients, the workforce and the NHS.