Using realist approaches to explain and understand the optimal use of paramedics in primary care.

Problem

In response to the unsustainable workload and workforce crises in primary care, paramedics (with their generalist clinical background acquired from ambulance service experience) are increasingly employed in primary care. However, the specific contribution paramedics can offer to the primary care workforce has not been distinctly outlined.

Approach

A realist evaluation was undertaken, consisting of three inter-related research studies:- In Phase I, a mixed-methods cross-sectional survey of paramedics in primary care in the UK was conducted to comprehend the existing practices of paramedics within the NHS.- Phase II involved an analytic auto-netnography, where online conversations among paramedics in primary care were observed in order to understand paramedics' perceptions of their role.- Phase III consisted of focused observations were undertaken of paramedics working in primary care in 15 sites across England, Northern Ireland, Scotland, and Wales. 60 interviews were undertaken with paramedics (n=15), patients (or carers) who had received care from paramedics working in primary care (n=15), general practitioners who worked with paramedics (n=15), as well as other professionals employed in primary care, such as nurses and pharmacists, and administrative staff (n=15).

Findings

The culmination of findings from each phase led to the development of a final programme theory, encompassing three conceptual categories: Expectations associated with paramedics in primary care, the transition of paramedics into primary care roles, and the roles and responsibilities of paramedics in primary care. Based on the evidence generated, there are four key recommendations regarding how paramedics work in primary care:1. A clear strategy for communication of the paramedic’s role in primary care2. Developing a comprehensive curriculum framework for paramedics inprimary care3. The need for an effective transition support structure4. Changes to legislation and policy

Consequences

This research builds on previous work in this area, capturing the perspectives of the professionals who work with paramedics in primary care, patients they have seen, as well as of paramedics themselves. This research uses a novel approach to present empirical evidence of the role of paramedics in primary care across the UK, and offers insights into factors relating to their deployment, employment, and how they fit in within the wider primary care team. On this basis, we have produced a series of practice implementation recommendations - as well as highlighted areas for further research in this area.