Contribution of paramedics in primary and urgent care: a systematic review

Georgette Eaton; Geoff Wong; Veronika Williams; Nia Roberts; Kamal R Mahtani

doi:10.3399/bjgp20X709877

Abstract

Background Within the UK, there are now opportunities for paramedics to work across a variety of healthcare settings away from their traditional ambulance service employer, with many opting to move into primary care.

Aim To provide an overview of the types of clinical roles paramedics are undertaking in primary and urgent care settings within the UK.

Design and setting A systematic review.

Method Searches were conducted of MEDLINE, CINAHL, Embase, the National Institute for Health and Care Excellence, the Journal of Paramedic Practice, and the Cochrane Database from January 2004 to March 2019 for papers detailing the role, scope of practice, clinician and patient satisfaction, and costs of paramedics in primary and urgent care settings. Free-text keywords and subject headings focused on two key concepts: paramedic and general practice/primary care.

Results In total, 6765 references were screened by title and/or abstract. After full-text review, 24 studies were included. Key findings focused on the description of the clinical role, the clinical work environment, the contribution of paramedics to the primary care workforce, the clinical activities they undertook, patient satisfaction, and education and training for paramedics moving from the ambulance service into primary care.

Conclusion Current published research identifies that the role of the paramedic working in primary and urgent care is being advocated and implemented across the UK; however, there is insufficient detail regarding the clinical contribution of paramedics in these clinical settings. More research needs to be done to determine how, why, and in what context paramedics are now working in primary and urgent care, and what their overall contribution is to the primary care workforce.

INTRODUCTION

Within the UK, there are now opportunities for paramedics to work across a variety of healthcare settings, away from their traditional ambulance service employer. These settings include acute hospital trusts, forensic health care, minor injury units, GP services, and urgent care centres.¹^–⁴

The NHS Long Term Plan⁵ further advocates the use of paramedics in primary care and the new 5-year framework for general practice contracts outlines funding support for ‘first contact community paramedics’ to be employed within primary care settings from 2021.⁵ This may be appealing to some paramedics wishing to further develop their professional practice in this setting;⁶ therefore, they are among the group of allied health professionals who are attractive to GP surgeries based on this funding. As paramedics transition into these roles within primary care, their knowledge and skill set will undoubtedly change and grow,⁷^–⁹ offering career development outside of the ambulance service.

The aim of this review was to describe the key reported findings from the current published UK literature available in this field, and to identify gaps in the evidence base since the last systematic review on the subject.¹⁰

METHOD

This is a systematic review, conducted using guidance from the Joanna Briggs Institute.¹¹ Findings are reported according to the extension for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.¹² Prior to commencing this review, a study protocol was developed and registered with PROSPERO (ref: CRD42018109414).

Information sources

A sensitive search strategy was developed for MEDLINE (Ovid, January 2004 to third week of January 2019) and then translated to other databases. These were CINAHL (EBSCO, January 2004 to third week of January 2019); Embase (Ovid, January 2004 to third week of January 2019); National Institute for Health and Care Excellence (January 2004 to first week of February 2019); and Cochrane Database of Systematic Reviews (Cochrane Library, Wiley; January 2004 to third week of January 2019). Reference lists were screened and forward citation searches conducted for included studies. The Journal of Paramedic Practice (January 2004 to first week of March 2019) was hand-searched.

Search strategy

Databases were searched using free-text keywords and subject headings for the two key concepts: paramedic and general practice/primary care (see Supplementary Box S1 for details). Search terms describing scope of practice were not added because the aim was to retrieve all studies focusing on paramedics in primary care, regardless of clinical presentation or assessment. The search was limited from January 2004, to capture studies published since the last systematic review on the subject.¹⁰ No methodological filters or language limits were applied.

Encouraged by the recent NHS Long Term Plan and the new 5-year framework for GP contracts, paramedics are being employed within primary care settings across the UK. The evidence within this review identifies that the role of the paramedic working in primary care is being advocated and implemented across the UK, with a greater range of autonomy and higher education levels. However, there is insufficient detail within the published literature regarding the clinical contribution paramedics make to the primary and urgent care workforce.

How this fits in

Study selection

A priori definitions and justifications for the screening criteria are outlined in Supplementary Box S2. Studies were selected for inclusion against the following criteria:

Population: paramedics working within the UK only.
Concept: information relating to role, scope of practice, work within health and social care systems, patient and carer satisfaction, clinician satisfaction, and costs.
Context: working fully or partly in primary care settings, out-of-hours, urgent care centres, minor injury units, or walk-in centres.
Study design: any literature (quantitative or qualitative) that presents information relevant to the purpose of this review was considered for inclusion.

Titles and abstracts were screened in order to include or exclude records according to eligibility criteria. Duplicate studies were excluded using reference management software Mendeley (version 1.19.4). The full text of potentially eligible studies was retrieved and originally assessed for eligibility by one author. Full-text studies were independently screened by a second author. Comparisons of study selections were made between both authors. Where any discrepancy arose, they were discussed with a third author until a consensus had been reached.

Data extraction

To extract data from included studies, an amended data extraction form was adapted from the Joanna Briggs Institute’s standardised template¹¹ and included:

objectives;
questions;
population;
concept;
context;
study methodology;
study citation; and
findings relating to the themes of the previous review,¹⁰ including role, scope of practice, education, and commissioning.

Information was obtained from published studies. No authors were contacted for further information as reported methods and results were clear. Data extraction was undertaken by one author and discussed among the remaining authors.

Analysis

Data from all included studies were discussed between all authors. The included studies were described and summarised in a tabular form. Then, a coding framework was iteratively developed to present the key findings from the data extraction. A narrative synthesis was used to describe the nature and scope of the reported findings within the studies identified. In keeping with this methodology, quality appraisal of included studies was not carried out.¹¹

RESULTS

A total of 6765 citations were identified through database searching (see Supplementary Figure S1 for details). Following screening of titles and abstracts against the inclusion and exclusion criteria, 202 full-text studies were retrieved. After applying inclusion and exclusion criteria, 24 relevant full-text studies were identified. No new studies that had not already been considered were found upon screening the reference lists of these studies. The main reasons for exclusion were studies that reviewed practice outside of the UK (n = 137); where the paramedic was working within the ambulance service only (n = 22); and where the population could not be identified as being a paramedic because of the term ‘emergency care practitioner’ encompassing both nurse and paramedic disciplines (n = 14). There was complete agreement on inclusion/exclusion decisions from independent screening against eligibility criteria at the full-text stage.

Charting the results

For the characteristics of the 24 included studies selected for review (all of which were published in English) see Supplementary Table S1. Study design varied across the included studies, with seven including primary research,¹³^–¹⁹ two of secondary research,²⁰^,²¹ and the remaining comprising either a case study (n = 4),²²^–²⁵ commentary (n = 4),²⁶^–²⁹ report or strategic plan (n = 6),⁵^,³⁰^–³⁴ or protocol for future research (n = 1).³⁵

Key findings were iteratively grouped into the following headings:

description of the clinical role;
clinical work environment;
reduction in GP workload;
patient satisfaction;
clinical activities in primary care; and
education and training.

Description of the clinical role

Across the studies, the job title of the paramedic working in primary care differed, either being ‘paramedic’,¹⁶^,²³^,²⁷^–³⁰^,³²^,³⁴ ‘specialist paramedic’,¹⁸^,¹⁹^,²⁴ ‘paramedic practitioner’,¹⁴^,¹⁷^,²²^,³⁶ ‘emergency care practitioner’,¹⁴^,²¹^,²⁶^,³⁵ ‘advanced paramedic’,³²^,³³ or ‘community paramedic’.⁵^,³¹^,³³

The variety of titles was reported to be confusing for patients in two studies,¹³^,¹⁷ as well as other clinicians within primary care,¹⁹^,²¹^,²⁹ with concerns relating to the role, scope of practice, and autonomy of these paramedics.

Clinical work environment

In addition to variation in title, variation in clinical environment, in which paramedics were deployed, was also found. The studies reported paramedics working in commissioned home-visiting services,¹⁴^,¹⁷^,¹⁸^,²⁵^,³⁰^,³⁵ minor units¹⁵^,²⁰^,²¹^,²⁴^,³⁰ (including first aid units, minor injury units, minor departments in hospitals, and walk-in- centres), general practice,⁵^,¹⁴^,¹⁵^,¹⁹^,²²^,²⁷^,²⁸^,³¹^,³³^,³⁴ and out-of-hours.¹³^,¹⁶^,²⁴

In some studies, paramedics retained the ambulance service as their main employer and rotated through primary care settings.¹⁵^,¹⁸^–²¹^,²⁴^,²⁹

Reduction in GP workload

All studies reviewed reported the paramedic contributing to the primary care workforce through working within a multidisciplinary team. In some cases, the role of paramedics in primary care settings was specifically reported to decrease GP workload by assessing and treating urgent, non-complex patients.⁵^,¹⁸^,²²^,²³^,²⁷^,²⁸ However, two studies highlighted that patients may still prefer to see their registered GP, rather than a paramedic.¹⁷^,¹⁸

Another two of the included studies raised the issue that patients may not have a straightforward consultation with a paramedic if treatment needed to be clarified with a medical doctor,¹⁴^,¹⁵ thereby adding an extra step to the patient journey. In some areas, there was an expectation that the paramedic report to a more senior clinician for all patient cases.²³^,²⁶^,³³ Such referrals were reported as lengthening consultation time with little gain to the patient, and the paramedic role in these cases is of more limited value.

Other studies highlighted that the time paramedics spent with patients was generally longer than their physician or nursing counterparts within primary care,¹³^,¹⁵^,¹⁶^,¹⁹^,²¹ and so researchers questioned the benefit of their attendance from an economic standpoint. The slightly longer home-visits by paramedics was deemed a positive by patients in one study.¹⁷ Another study²¹ showed that the length of patient contact differed between clinical settings, typically being longer when paramedics were employed by ambulance services rather than in primary care. Reasons for this were not explored in the study, but it is worth noting that the pressure to see patients within a specific timeframe does not exist in the ambulance service, unlike in primary care.

Only one study associated paramedic roles in primary care with an overall cost saving,¹⁵ although this finding was an estimate and the study was authored in 2006; therefore, its relevance to today’s NHS is ambiguous.

Patient satisfaction

Three studies used retrospective comparators³⁷ to record patient satisfaction following treatment by a paramedic.¹³^,¹⁷^,¹⁸ Although these studies document high satisfaction levels from patients who were visited by a paramedic in their home, in two studies a small minority of patients remained keen to be assessed by their GP,¹⁷^,¹⁸ and other patients remained unclear about the purpose of the assessment undertaken by the paramedic.¹³

Clinical activities in primary care

The role of the paramedic in primary care varied little across studies, highlighting that paramedics who undertake roles in primary care (under whichever title) generally undertake similar roles that focus on the undifferentiated, undiagnosed patient. These include minor injury and illness clinics,¹⁵^,¹⁹^,²²^–²⁴^,²⁸^,³³^,³⁴ home-visiting,¹⁴^,¹⁷^–¹⁹^,²²^,²³^,²⁵^,²⁸^,³⁰^,³³^,³⁵ and using paramedic-specific skills (such as 12-lead electrocardiogram [ECG] interpretation) to assist in general health assessment.²²^–²⁴^,²⁸^,²⁹^,³¹^,³⁴ There was no mention of paramedics providing high-acuity care within these settings, but it was acknowledged that one of the advantages brought by paramedics was their ability to provide high-acuity or emergency care.²³^,²⁴^,²⁷^,²⁸

Four case studies¹⁴^,²²^–²⁴ and one report³⁴ presented typical days for paramedics working in primary care settings of GP surgeries and a rural first aid unit. The type of work undertaken across these case studies is similar, indicating that paramedics working in clinical primary and urgent care roles tend to adopt a similar working day.

Education and training

Education standards for paramedics working in primary and urgent care were explicitly mentioned in eight studies.¹⁴^–¹⁶^,¹⁹^,²¹^,²⁶^,³⁴^,³⁸ However, none of the publications by NHS England⁵^,²⁵^,³¹ considered elements relating to education for paramedics working in primary and urgent care. Postgraduate education was outlined as a requirement for paramedics to work in primary and urgent care,¹⁴^–¹⁶^,¹⁹^,²¹^,²⁶^,³⁴^,³⁸ in line with the guidance outlined by the College of Paramedics;³⁹ however, there was little detail on the specific competencies required to work in these settings. One study¹⁶ highlighted the importance of supervision and mentoring for paramedics as they entered primary or urgent care roles, whereas another²² outlined how paramedics may also be used to provide mentorship to training physician assistants and nurses (for a brief summation of these findings, see Supplementary Box S3).

DISCUSSION

Summary

This review has set out the scope and content from the literature, published since the seminal study on the subject in 2005.¹⁰ In the time since that review was published, the role of the ambulance service has changed substantially, and the role of the paramedic has subsequently evolved. Now, just 8% of 999 emergency ambulance calls are for people with life-threatening illnesses or injuries,³⁸ suggesting that a large proportion of patients access the ambulance service with lower-acuity presentations. This has subsequently caused a change in what is expected of a paramedic. As well as emergency care and advanced life support, paramedics now need to be skilled in managing acute-on-chronic long-term conditions, acute presentations of mental ill-health, social care assessments, and a range of undifferentiated urgent care presentations.⁷^,⁸ New legislation supports non-medical prescribing by advanced paramedics, allowing these paramedics to ‘complete’ patient care and avoid referrals for secondary assessments and treatment. With changing demand on the health and social care services, more higher education thresholds, and social dependence on the ambulance service,⁴⁰ the modern paramedic has evolved to become a generalist.

Strengths and limitations

These results should be considered in the light of some limitations. Despite creating and implementing a search strategy with the support of an information specialist, it is possible that relevant studies were missed. A decision was made to describe and map the evidence base. It was decided not to conduct formal meta-analysis exploring the effectiveness of paramedics in primary and urgent care, nor to critically assess the quality of the research.

Comparison with existing literature

There is some evidence in this review to suggest that paramedics may be able to apply their extended skills to safely assess and treat patients in primary care,²⁰ and that the role of paramedics working in primary and urgent care settings is received positively.¹³^,¹⁷^,¹⁹^,²⁰^,²⁸ However, there is also evidence which demonstrates that patients perceive the role and responsibilities of paramedics in primary care settings as unclear,¹³^,¹⁷ perhaps not helped by the differences in title and scope of practice across clinical settings.¹⁴^,²¹ The College of Paramedics has made distinctions between ‘paramedics’, ‘specialist paramedics’, and ‘advanced paramedics’,³⁹ and advocated against the use of the term ‘emergency care practitioner’ to describe paramedics in extended roles. This review highlights both the variety of job titles paramedics working in primary and urgent care operate under, as well as the lack of uptake of the professional body’s recommendations on the job titles of registered paramedics. It is interesting to note that the two most recent documents by NHS England⁵^,³¹ refer to paramedics working within primary care under two different job titles (‘first contact community paramedic’ and ‘community paramedic’), neither of which are endorsed nor used by the professional body.

This review also indicates the variety of settings in which paramedics are working, and the broadly similar roles paramedics are employed in. Within these diverse settings paramedics are likely to encounter patients presenting with conditions of lower acuity. Such patients may not fully utilise the unique skill sets of seeing paramedics, who on the whole are trained to manage urgent and emergency presentations.²⁴^,²⁷^,²⁸^,³⁴

Implications for research and practice

What is clear from this review is the lack of standardisation across the UK. For example, the role of the paramedic in Northumberland³³ and Salford²² is broadly similar to the role in Oxfordshire²⁴ in terms of scope of practice, but there are differences in the level of autonomy. The in-hours Northumberland model relies on GPs retaining oversight and control, whereas the in-hours model in Salford promotes greater autonomy, as does the out-of-hours role in Oxfordshire. There is no differentiation of autonomy in studies where paramedics worked in minor injury units,¹⁵^,²⁰^,²¹^,³⁰ and paramedics who rotated from the ambulance service were still expected to report to the senior clinician (usually the GP) while in the primary care setting.¹⁶^,¹⁹^,³²^,³⁴ This was generally attributed to the inability of paramedics to prescribe medicines at the time these studies were written.²²^,²⁸ The level of autonomy afforded to paramedics working in these settings requires further investigation if paramedics are to be employed optimally in the NHS. Although postgraduate education is deemed a necessity to work in primary and urgent care settings¹⁴^–¹⁶^,¹⁹^,²¹^,²⁶^,³⁴^,³⁸^,³⁹ the lack of standardisation makes the development of training programmes to prepare paramedics to work in these settings difficult.

The first 5-year framework for GP contracts initially outlined paramedics working in primary care should be paid at Agenda-for-Change Band 6,³¹ yet the study by Turner and Williams¹⁹ found that Band 6 posts were considered training posts with supervision and mentoring within primary and urgent care. The most recent update has outlined that paramedics, included into the reimbursement scheme from April 2021, will be reimbursed up to an indicative Agenda-for-Change Band 7 rate.⁴¹ The update further outlined that, to qualify as an advanced paramedic practitioner, a relevant Master’s degree is the level of education required for this role. This more accurately represents the degree of autonomy paramedics can have, and also outlines the range of patients they can safely manage. However, this document continues to conflate titles, using both terms ‘community paramedic’ and ‘advanced paramedic practitioners’.

Although several studies make the claim that paramedics in primary care may provide cost savings, only one study provided any empirical data to back up this claim and the data were only estimates.¹⁵ Further evidence needs to be gathered to determine whether paramedics in primary care are able to reduce costs, perhaps by directing GP time to more complex patients with chronic conditions, and to managing both lower- and higher-acuity same-day presentations autonomously.

The evidence within this review identifies that the role of the paramedic working in primary and urgent care is being advocated and implemented across the UK, but fails to provide sufficient detail regarding the clinical contribution of paramedics in this clinical setting. If primary care employers are to see the full potential of paramedics working in these settings, more research needs to be done to determine how, why, and in what context paramedics are now working in primary and urgent care, and what their overall contribution is to the primary care workforce.

Acknowledgments

Georgette Eaton would like to thank Rachel Gardner, DPhil Student at the University of Oxford, for second-screening extracted articles.

Notes

Funding

Georgette Eaton acknowledges NHS Health Education England for its support of this research (ref: 190121). Kamal R Mahtani, Geoff Wong, and Nia Roberts are supported by the National Institute for Health Research (NIHR) School of Primary Care Research Evidence Synthesis Working Group (project 390). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, Health Education England, or the host institution.

Ethical approval

Not applicable.

Provenance

Freely submitted; externally peer reviewed.

Competing interests

Kamal R Mahtani is Chair and Geoff Wong is Joint Deputy Chair of the NIHR Health Technology Assessment Prioritisation Committee: Integrated Community Health and Social Care Panel (A).

Discuss this article

Contribute and read comments about this article: bjgp.org/letters

Received October 7, 2019.
Revision requested November 3, 2019.
Accepted December 5, 2019.

©The Authors

http://creativecommons.org/licenses/by-nc/4.0/

This article is Open Access: CC BY-NC 4.0 licence (http://creativecommons.org/licences/by-nc/4.0/).

REFERENCES

1.↵
1. Evans R,
2. McGovern R,
3. Birch J,
4. Newbury-Birch D
Which extended paramedic skills are making an impact in emergency care and can be related to the UK paramedic system? A systematic review of the literatureEmerg Med J2014317594603
OpenUrl Abstract/FREE Full Text
2.
1. Mahtani KR,
2. Eaton G,
3. Catterall M,
4. et al.
Setting the scene for paramedics in general practice: what can we expect?J R Soc Med20181116195198
OpenUrl CrossRef PubMed
3.
1. O’Meara P
Community paramedics: a scoping review of their emergence and potential impactInt Paramed Pract201441512
OpenUrl
4.↵
1. Williams B,
2. Fielder C,
3. Strong G,
4. et al.
Are paramedic students ready to be professional? An international comparison studyInt Emerg Nurs2015232120126
OpenUrl
5.↵
1. NHS England
The NHS Long Term Plan2019www.longtermplan.nhs.uk (accessed 6 Apr 2020).
6.↵
1. Eaton G,
2. Mahtani K,
3. Catterall M
The evolving role of paramedics — a NICE problem to have?J Health Serv Res Policy2018233193195
OpenUrl CrossRef PubMed
7.↵
1. National Institute for Health and Care Excellence
Paramedics with enhanced competenciesEmergency and acute medical care in over 16s: service delivery and organisationLondonNICE2017https://www.nice.org.uk/guidance/gid-cgwave0734/documents/draft-guideline-3 (accessed 6 Apr 2020).
8.↵
1. National Institute for Health and Care Excellence
Paramedic remote supportEmergency and acute medical care in over 16s: service delivery and organisationLondonNICE2017https://www.nice.org.uk/guidance/GID-CGWAVE0734/documents/draft-guideline-4 (accessed 6 Apr 2020).
9.↵
1. Primary Care Workforce Commission
The future of primary care: creating teams for tomorrow2015https://www.hee.nhs.uk/sites/default/files/documents/The%20Future%20of%20Primary%20Care%20report.pdf (accessed 6 Apr 2020).
10.↵
1. Ball L
Setting the scene for the paramedic in primary care: a review of the literatureEmerg Med J20052212896900
OpenUrl Abstract/FREE Full Text
11.↵
1. Aromataris E,
2. Munn Z
1. Peters M,
2. Godfrey C,
3. McInerney P,
4. et al.
Scoping reviewsAromataris E, Munn ZJoanna Briggs Institute reviewer’s manual2017https://reviewersmanual.joannabriggs.org (accessed 6 Apr 2020).
12.↵
1. Tricco AC,
2. Lillie E,
3. Zarin W,
4. et al.
PRISMA extension for Scoping Reviews (PRISMA-ScR): checklist and explanationAnn Intern Med20181697467473
OpenUrl CrossRef PubMed
13.↵
1. Halter M,
2. Marlow T,
3. Mohammed D,
4. Ellison GTH
A patient survey of out-of-hours care provided by emergency care practitionersBMC Emerg Med200774
OpenUrl CrossRef PubMed
14.↵
1. Lattimer V,
2. Burgess A,
3. Knapp F,
4. et al.
The impact of changing workforce patterns in emergency and urgent out-of-hours care on patient experience, staff practice and health system performance: final report for the National Institute for Health Research Service Delivery and Organisation programme2010http://www.netscc.ac.uk/hsdr/files/project/SDO_FR_08-1519-97_V01.pdf (accessed 6 Apr 2020).
15.↵
1. Mason S,
2. Coleman P,
3. O’Keeffe C,
4. et al.
The evolution of the emergency care practitioner role in England: experiences and impactEmerg Med J2006236435439
OpenUrl Abstract/FREE Full Text
16.↵
1. Moule P,
2. Clompus S,
3. Lockyer L,
4. et al.
Preparing non-medical clinicians to deliver GP out-of-hours services: lessons learned from an innovative approachEduc Prim Care2018296376380
OpenUrl CrossRef PubMed
17.↵
1. Proctor A
Home visits from paramedic practitioners in general practice: patient perceptionsJ Paramed Pract2019113115121
OpenUrl
18.↵
1. RSM UK Group
Better local care Hampshire multispecialty community provider vanguard. Deep dive evaluation report: paramedic home visiting serviceRSM UK Group2017
19.↵
1. Turner J,
2. Williams J
An evaluation of early stage development of rotating paramedic model pilot sites2018https://uhra.herts.ac.uk/bitstream/handle/2299/21174/Rotating_Paramedics_Final_Report.pdf? (accessed 6 Apr 2020).
20.↵
1. Turner J,
2. Coster J,
3. Chambers D,
4. et al.
What evidence is there on the effectiveness of different models of delivering urgent care? A rapid reviewHealth Serv Deliv Res20153431160
OpenUrl
21.↵
1. Hill H,
2. McMeekin P,
3. Price C
A systematic review of the activity and impact of emergency care practitioners in the NHSEmerg Med J20143110853860
OpenUrl Abstract/FREE Full Text
22.↵
1. Brown P
A day in the life of a paramedic advanced clinical practitioner in primary careJ Paramed Pract201799378386
OpenUrl
23.↵
1. Daly J
The paramedic in the community: my storyPrim Health Care20132291619
OpenUrl
24.↵
1. Eaton G
Taking healthcare to the community: the evolving role of paramedicsJ Paramed Pract201795190191
OpenUrl
25.↵
1. NHS England
Practice based paramedics, S Kent coast2017https://www.england.nhs.uk/wp-content/uploads/2016/03/releas-capcty-case-study-4138.pdf (accessed 6 Apr 2020).
26.↵
1. Scott J,
2. Carney C
Emergency care practitionersEmerg Med J2004213273274
OpenUrl FREE Full Text
27.↵
1. Spence D
Bad medicine: good medicine — the GP paramedicBr J Gen Pract2017DOI: https://doi.org/10.3399/bjgp17X691445.
28.↵
1. Spencer M
Skill mix: how paramedics can help general practiceGPonline201625Mayhttps://www.gponline.com/skill-mix-paramedics-help-general-practice/article/1396392 (accessed 6 Apr 2020).
29.↵
1. Woollard M
The role of the paramedic practitioner in the UKJ Emerg Prim Health Care200641
30.↵
1. NHS England
Prime Minister’s challenge fund: improving access to general practice First evaluation report: October 20152015https://www.england.nhs.uk/wp-content/uploads/2015/10/pmcf-wv-one-eval-report.pdf (accessed 6 Apr 2020).
31.↵
1. NHS England
Investment and evolution: a five-year framework for GP contract reform to implementThe NHS Long Term Plan.2019https://www.england.nhs.uk/wp-content/uploads/2019/01/gp-contract-2019.pdf (accessed 6 Apr 2020).
32.↵
1. NHS Wales
Our plan for a primary care service for Wales up to March 20182014http://www.wales.nhs.uk/sitesplus/documents/986/our%20plan%20for%20primary%20care%20in%20wales%20up%20to%20march%202018.pdf (accessed 6 Apr 2020).
33.↵
1. Northumberland Local Medical Committee, Northumberland Clinical Commissioning Group
A primary care strategy for Northumberland 2016–2020: a vision for a vibrant and sustainable future for primary care2016
34.↵
1. NHS Fareham and Gosport and South Eastern Hampshire Clinical Commissioning Groups
A guide for general practice employing a paramedic2018http://www.wessexdeanery.nhs.uk/pdf/2018%2006%2005%20Employing%20a%20Paramedic%20in%20Primary%20Care%20Toolkit%20v4.pdf (accessed 6 Apr 2020).
35.↵
1. Abrams R,
2. Wong G,
3. Mahtani KR,
4. et al.
Understanding the impact of delegated home visiting services accessed via general practice by community-dwelling patients: a realist review protocolBMJ Open2018811e024876
OpenUrl Abstract/FREE Full Text
36.↵
1. NHS England
Allied health professions into action: using allied health professionals to transform health, care and wellbeing 2016/17–2020/212017https://www.england.nhs.uk/wp-content/uploads/2017/01/ahp-action-transform-hlth.pdf (accessed 6 Apr 2020).
37.↵
1. Pinnock H,
2. Epiphaniou E,
3. Pearce G,
4. et al.
Implementing supported self-management for asthma: a systematic review and suggested hierarchy of evidence of implementation studies.BMC Med201513127
OpenUrl CrossRef PubMed
38.↵
1. Keogh B
Ambulance response programme2017https://www.england.nhs.uk/wp-content/uploads/2017/07/ambulance-response-programme-letter.pdf (accessed 6 Apr 2020).
39.↵
1. College of Paramedics
Digital career framework2017https://www.collegeofparamedics.co.uk/COP/Professional_development/Digital_Career_Framework/COP/ProfessionalDevelopment/Digital_Career_Framework.aspx?hkey=5058228a-13ef-4d38-a7b0-255e6263c9f7 (accessed 15 Apr 2020).
40.↵
1. Wankhade P
Cultural characteristics in the ambulance service and its relationship with organisational performance: evidence from the UK2010https://www.academia.edu/920660/Cultural_characteristics_in_the_ambulance_service_and_its_relationship_with_organisational_performance_evidence_from_the_UK (accessed 6 Apr 2020).
41.↵
1. NHS England
Update to the GP contract agreement 2020/21–2023/242020https://www.england.nhs.uk/wp-content/uploads/2020/03/update-to-the-gp-contract-agreement-v2-updated.pdf (accessed 15 Apr 2020).

In this issue

Download PDF

Email Article

Citation Tools

Keywords

More in this TOC Section

Show more Research

Cited By...

Intended for Healthcare Professionals

[1] 1.↵
Evans R,
McGovern R,
Birch J,
Newbury-Birch D
Which extended paramedic skills are making an impact in emergency care and can be related to the UK paramedic system? A systematic review of the literatureEmerg Med J2014317594603
OpenUrl Abstract/FREE Full Text

[2] Evans R,

[3] McGovern R,

[4] Birch J,

[5] Newbury-Birch D

[6] 2.
Mahtani KR,
Eaton G,
Catterall M,
et al.
Setting the scene for paramedics in general practice: what can we expect?J R Soc Med20181116195198
OpenUrl CrossRef PubMed

[7] Mahtani KR,

[8] Eaton G,

[9] Catterall M,

[10] et al.

[11] 3.
O’Meara P
Community paramedics: a scoping review of their emergence and potential impactInt Paramed Pract201441512
OpenUrl

[12] O’Meara P

[13] 4.↵
Williams B,
Fielder C,
Strong G,
et al.
Are paramedic students ready to be professional? An international comparison studyInt Emerg Nurs2015232120126
OpenUrl

[14] Williams B,

[15] Fielder C,

[16] Strong G,

[17] et al.

[18] 5.↵
NHS England
The NHS Long Term Plan2019www.longtermplan.nhs.uk (accessed 6 Apr 2020).

[19] NHS England

[20] 6.↵
Eaton G,
Mahtani K,
Catterall M
The evolving role of paramedics — a NICE problem to have?J Health Serv Res Policy2018233193195
OpenUrl CrossRef PubMed

[21] Eaton G,

[22] Mahtani K,

[23] Catterall M

[24] 7.↵
National Institute for Health and Care Excellence
Paramedics with enhanced competenciesEmergency and acute medical care in over 16s: service delivery and organisationLondonNICE2017https://www.nice.org.uk/guidance/gid-cgwave0734/documents/draft-guideline-3 (accessed 6 Apr 2020).

[25] National Institute for Health and Care Excellence

[26] 8.↵
National Institute for Health and Care Excellence
Paramedic remote supportEmergency and acute medical care in over 16s: service delivery and organisationLondonNICE2017https://www.nice.org.uk/guidance/GID-CGWAVE0734/documents/draft-guideline-4 (accessed 6 Apr 2020).

[27] National Institute for Health and Care Excellence

[28] 9.↵
Primary Care Workforce Commission
The future of primary care: creating teams for tomorrow2015https://www.hee.nhs.uk/sites/default/files/documents/The%20Future%20of%20Primary%20Care%20report.pdf (accessed 6 Apr 2020).

[29] Primary Care Workforce Commission

[30] 10.↵
Ball L
Setting the scene for the paramedic in primary care: a review of the literatureEmerg Med J20052212896900
OpenUrl Abstract/FREE Full Text

[31] Ball L

[32] 11.↵
Aromataris E,
Munn Z
Peters M,
Godfrey C,
McInerney P,
et al.
Scoping reviewsAromataris E, Munn ZJoanna Briggs Institute reviewer’s manual2017https://reviewersmanual.joannabriggs.org (accessed 6 Apr 2020).

[33] Aromataris E,

[34] Munn Z

[35] Peters M,

[36] Godfrey C,

[37] McInerney P,

[38] et al.

[39] 12.↵
Tricco AC,
Lillie E,
Zarin W,
et al.
PRISMA extension for Scoping Reviews (PRISMA-ScR): checklist and explanationAnn Intern Med20181697467473
OpenUrl CrossRef PubMed

[40] Tricco AC,

[41] Lillie E,

[42] Zarin W,

[43] et al.

[44] 13.↵
Halter M,
Marlow T,
Mohammed D,
Ellison GTH
A patient survey of out-of-hours care provided by emergency care practitionersBMC Emerg Med200774
OpenUrl CrossRef PubMed

[45] Halter M,

[46] Marlow T,

[47] Mohammed D,

[48] Ellison GTH

[49] 14.↵
Lattimer V,
Burgess A,
Knapp F,
et al.
The impact of changing workforce patterns in emergency and urgent out-of-hours care on patient experience, staff practice and health system performance: final report for the National Institute for Health Research Service Delivery and Organisation programme2010http://www.netscc.ac.uk/hsdr/files/project/SDO_FR_08-1519-97_V01.pdf (accessed 6 Apr 2020).

[50] Lattimer V,

[51] Burgess A,

[52] Knapp F,

[53] et al.

[54] 15.↵
Mason S,
Coleman P,
O’Keeffe C,
et al.
The evolution of the emergency care practitioner role in England: experiences and impactEmerg Med J2006236435439
OpenUrl Abstract/FREE Full Text

[55] Mason S,

[56] Coleman P,

[57] O’Keeffe C,

[58] et al.

[59] 16.↵
Moule P,
Clompus S,
Lockyer L,
et al.
Preparing non-medical clinicians to deliver GP out-of-hours services: lessons learned from an innovative approachEduc Prim Care2018296376380
OpenUrl CrossRef PubMed

[60] Moule P,

[61] Clompus S,

[62] Lockyer L,

[63] et al.

[64] 17.↵
Proctor A
Home visits from paramedic practitioners in general practice: patient perceptionsJ Paramed Pract2019113115121
OpenUrl

[65] Proctor A

[66] 18.↵
RSM UK Group
Better local care Hampshire multispecialty community provider vanguard. Deep dive evaluation report: paramedic home visiting serviceRSM UK Group2017

[67] RSM UK Group

[68] 19.↵
Turner J,
Williams J
An evaluation of early stage development of rotating paramedic model pilot sites2018https://uhra.herts.ac.uk/bitstream/handle/2299/21174/Rotating_Paramedics_Final_Report.pdf? (accessed 6 Apr 2020).

[69] Turner J,

[70] Williams J

[71] 20.↵
Turner J,
Coster J,
Chambers D,
et al.
What evidence is there on the effectiveness of different models of delivering urgent care? A rapid reviewHealth Serv Deliv Res20153431160
OpenUrl

[72] Turner J,

[73] Coster J,

[74] Chambers D,

[75] et al.

[76] 21.↵
Hill H,
McMeekin P,
Price C
A systematic review of the activity and impact of emergency care practitioners in the NHSEmerg Med J20143110853860
OpenUrl Abstract/FREE Full Text

[77] Hill H,

[78] McMeekin P,

[79] Price C

[80] 22.↵
Brown P
A day in the life of a paramedic advanced clinical practitioner in primary careJ Paramed Pract201799378386
OpenUrl

[81] Brown P

[82] 23.↵
Daly J
The paramedic in the community: my storyPrim Health Care20132291619
OpenUrl

[83] Daly J

[84] 24.↵
Eaton G
Taking healthcare to the community: the evolving role of paramedicsJ Paramed Pract201795190191
OpenUrl

[85] Eaton G

[86] 25.↵
NHS England
Practice based paramedics, S Kent coast2017https://www.england.nhs.uk/wp-content/uploads/2016/03/releas-capcty-case-study-4138.pdf (accessed 6 Apr 2020).

[87] NHS England

[88] 26.↵
Scott J,
Carney C
Emergency care practitionersEmerg Med J2004213273274
OpenUrl FREE Full Text

[89] Scott J,

[90] Carney C

[91] 27.↵
Spence D
Bad medicine: good medicine — the GP paramedicBr J Gen Pract2017DOI: https://doi.org/10.3399/bjgp17X691445.

[92] Spence D

[93] 28.↵
Spencer M
Skill mix: how paramedics can help general practiceGPonline201625Mayhttps://www.gponline.com/skill-mix-paramedics-help-general-practice/article/1396392 (accessed 6 Apr 2020).

[94] Spencer M

[95] 29.↵
Woollard M
The role of the paramedic practitioner in the UKJ Emerg Prim Health Care200641

[96] Woollard M

[97] 30.↵
NHS England
Prime Minister’s challenge fund: improving access to general practice First evaluation report: October 20152015https://www.england.nhs.uk/wp-content/uploads/2015/10/pmcf-wv-one-eval-report.pdf (accessed 6 Apr 2020).

[98] NHS England

[99] 31.↵
NHS England
Investment and evolution: a five-year framework for GP contract reform to implementThe NHS Long Term Plan.2019https://www.england.nhs.uk/wp-content/uploads/2019/01/gp-contract-2019.pdf (accessed 6 Apr 2020).

[100] NHS England

[101] 32.↵
NHS Wales
Our plan for a primary care service for Wales up to March 20182014http://www.wales.nhs.uk/sitesplus/documents/986/our%20plan%20for%20primary%20care%20in%20wales%20up%20to%20march%202018.pdf (accessed 6 Apr 2020).

[102] NHS Wales

[103] 33.↵
Northumberland Local Medical Committee, Northumberland Clinical Commissioning Group
A primary care strategy for Northumberland 2016–2020: a vision for a vibrant and sustainable future for primary care2016

[104] Northumberland Local Medical Committee, Northumberland Clinical Commissioning Group

[105] 34.↵
NHS Fareham and Gosport and South Eastern Hampshire Clinical Commissioning Groups
A guide for general practice employing a paramedic2018http://www.wessexdeanery.nhs.uk/pdf/2018%2006%2005%20Employing%20a%20Paramedic%20in%20Primary%20Care%20Toolkit%20v4.pdf (accessed 6 Apr 2020).

[106] NHS Fareham and Gosport and South Eastern Hampshire Clinical Commissioning Groups

[107] 35.↵
Abrams R,
Wong G,
Mahtani KR,
et al.
Understanding the impact of delegated home visiting services accessed via general practice by community-dwelling patients: a realist review protocolBMJ Open2018811e024876
OpenUrl Abstract/FREE Full Text

[108] Abrams R,

[109] Wong G,

[110] Mahtani KR,

[111] et al.

[112] 36.↵
NHS England
Allied health professions into action: using allied health professionals to transform health, care and wellbeing 2016/17–2020/212017https://www.england.nhs.uk/wp-content/uploads/2017/01/ahp-action-transform-hlth.pdf (accessed 6 Apr 2020).

[113] NHS England

[114] 37.↵
Pinnock H,
Epiphaniou E,
Pearce G,
et al.
Implementing supported self-management for asthma: a systematic review and suggested hierarchy of evidence of implementation studies.BMC Med201513127
OpenUrl CrossRef PubMed

[115] Pinnock H,

[116] Epiphaniou E,

[117] Pearce G,

[118] et al.

[119] 38.↵
Keogh B
Ambulance response programme2017https://www.england.nhs.uk/wp-content/uploads/2017/07/ambulance-response-programme-letter.pdf (accessed 6 Apr 2020).

[120] Keogh B

[121] 39.↵
College of Paramedics
Digital career framework2017https://www.collegeofparamedics.co.uk/COP/Professional_development/Digital_Career_Framework/COP/ProfessionalDevelopment/Digital_Career_Framework.aspx?hkey=5058228a-13ef-4d38-a7b0-255e6263c9f7 (accessed 15 Apr 2020).

[122] College of Paramedics

[123] 40.↵
Wankhade P
Cultural characteristics in the ambulance service and its relationship with organisational performance: evidence from the UK2010https://www.academia.edu/920660/Cultural_characteristics_in_the_ambulance_service_and_its_relationship_with_organisational_performance_evidence_from_the_UK (accessed 6 Apr 2020).

[124] Wankhade P

[125] 41.↵
NHS England
Update to the GP contract agreement 2020/21–2023/242020https://www.england.nhs.uk/wp-content/uploads/2020/03/update-to-the-gp-contract-agreement-v2-updated.pdf (accessed 15 Apr 2020).

[126] NHS England

Main menu

User menu

Search