By Dr Mark Spencer on the 25 May 2016
Dr Mark Spencer, co-chair of the New NHS Alliance, employs a paramedic in his practice. He explains what the role involves and how it benefits the practice.
Paramedics are fleetingly mentioned within Dr Arvin Madan’s introduction to the recently published GP Forward View. They are also included again in the ‘Ten High Impact Actions’. Blink, though, and you would miss those references.
So, what is their role and what are they currently doing within day-to-day general practice?
At FCMS, the healthcare provider of which I am medical director, we have had paramedics filling urgent care shifts for over a decade. Way back in 2002 we were awarded the Health and Social Care Award in the emergency care category for our development of a multidisciplinary team in the GP out-of-hours setting. The team included GPs, primary care nurses, mental health nurses, pharmacists, dentists, social workers and paramedics.
So, what about ‘in-hours’ GP practices?
The past two years has seen my own practice move from predominantly GP dominated provision of day-to-day appointments, to a more multidisciplinary approach. Practices nurses have stepped up the mark for the provision of care for patients with long-term conditions, but seeing patients who request an appointment has, until recently, pretty much remained the domain of the GP.
Our change came out of adversity and need. In the past two years we have lost two whole-time equivalent GPs as four part-time partners either retired or moved on. This meant we were only left with four whole-time equivalent GPs for over 12,000 patients in an area of high deprivation and high demand. Failure to recruit new GPs left us with no alternative but to think differently.
We developed a strategy that includes an acute access team, led by an on-call GP, but with the bulk of face-to-face delivery being undertaken by a full-time nurse practitioner, a full-time clinical pharmacist and a full-time paramedic.
Our paramedic has three basic elements to his job. First, he carries out a morning minor ailments surgery, working alongside, and being supported by, the other members of the acute access team. Late morning he then sets off on home visits, covering the vast majority of acute visits that would otherwise have been undertaken by a GP.
Use of technology
The use of telephone support, but more importantly, video support between the paramedic and the on-call GP, has significantly broadened the range of conditions that can safely be managed by the paramedic, with the on-call GP remaining back at surgery. The live video link allows the GP to see the patient, and also allows the patient and carers to interact directly with the GP as if they were in the room.
To date, the feedback from patients and carers has been excellent. To cover information governance, the patient signs a written consent form prior to, and immediately after, the video consultation. We have also had written confirmation from our local coroner that they would accept a death certificate from the GP following a video consultation should the patient pass away, in exactly the same way as they would if the GP had visited in person.
Releasing the GP from having to undertake acute visits has not only freed up a considerable amount of GP time, but has had a substantial effect on reducing GP stress levels.
Thie post was originally aired here: