An opportunity to future-proof the primary care workforce? A qualitative study of paramedic home visiting in primary care

Problem

Primary care services in England are at saturation point. Integrating community paramedics into primary care teams is advocated as an innovative way to build resilience in the primary care workforce. However, there is little evidence for the effectiveness of community paramedics working in primary care, or an understanding of how paramedics and GPs might develop interdisciplinary working. The aim of this project is to explore experiences and acceptability of an acute primary care home visiting service delivered by paramedics.

Approach

Three practices in a rural area of north east England, with a combined patient population of approximately 20,000 patients, piloted a paramedic acute home visiting service, between October 2018 and March 2019. Four focus groups were conducted, three with each primary healthcare team (14 participants) and one with five community paramedics, and nine individual patient interviews from across the three practices. Data were analysed using a modified thematic framework approach.

Findings

Community paramedics integrated successfully into primary care teams, to deliver an acute home visiting service. They relieved some of the workload pressures faced by GPs, providing increased time for care planning and other duties. Role perception and professional boundaries dominated the discourse within focus groups. Initially, GPs were apprehensive because of their preconceptions about the paramedic role and skillset, stemming from traditional professional identities. Collaboration was a key factor in mitigating this uncertainty and supporting interdisciplinary working. Paramedics had opportunities to discuss their clinical decisions with GPs, allowing the two professional groups to learn from each other. By the end of the pilot phase, GPs and paramedics were working together to define their roles and re-shape their professional boundaries. Patients held traditional perceptions of the paramedic role. Some feared a visit from a paramedic would result in hospital admission, or were concerned that paramedics were being taken away from their emergency response role. These fears were overcome as patients appreciated the interpersonal skills and thoroughness of paramedics. However, patients’ confidence in the paramedics was based on an awareness that they were working collaboratively with GPs.

Consequences

The introduction of paramedics into the primary care skill-mix provides an important opportunity to future-proof the primary care workforce. Practice teams need time to find a way of working with paramedics that fits their local context. Further research is required to assess the impact on healthcare outcomes such as conveyance to hospital, and to explore the potential of paramedics to take on other aspects of primary care, such as consultations in GP practices.