Piloting the use of paramedics in primary care in Dudley

To respond to challenges around GP workforce availability and capacity, Dudley Clinical Commissioning Group (CCG) developed a 12-month pilot to determine whether employing paramedics in primary care would help meet these challenges. The pilot used short-term funding to recruit two paramedics to work within local practices.

Arden & GEM’s transformation team worked in partnership with the CCG to develop an appropriate model of care and to design an evaluation process that assessed the successes, benefits and challenges of the pilot, and the impact of the new roles.

Understanding the challenge

GPs in Dudley had highlighted a number of workforce and capacity challenges as a result of increasing patient demand, retirement of GP partners and difficulties in recruiting new GPs.

Dudley CCG identified funding through the General Practice Resilience Programme – developed as part of the GP Five Year Forward View (2016) and supported within the NHS Long Term Plan (2019) – to establish two posts, as part of a pilot, to understand if paramedics could provide complimentary skills to the primary care workforce, to help meet these challenges.

The pilot’s aims were to release GP workforce capacity within the two practices, maintain or improve patient satisfaction, and reduce unnecessary attendances at A&E departments and Urgent Care Centres.

Developing a solution

Arden & GEM’s transformation team was approached to provide project management support for the pilot, alongside working with Dudley CCG to:

• develop the model of care to pilot within the GP practices, ensuring that latest best practice was utilised
• evaluate the impact on the practices involved.

A number of awareness and engagement sessions were facilitated to gage interest from GPs and bring together best practice from existing local and national schemes. This enabled the model to be tailored to meet the needs of the local population for each practice, as well as ensuring that elements which had been proven to work well were also included. For example, offering a home visiting service to a specific cohort of patients that were housebound or could not attend the GP practice.

The CSU provided support and guidance to the pilot practices in developing benefit measures, to include:

• patient satisfaction
• GP time release
• reduction in A&E and Urgent Care Centre attendances for an identified cohort of patients.

During the pilot, regular meetings and support for the practices were maintained. A summary report was produced at the end of the pilot and presented to the CCG Workforce Steering Group.

Outcomes

At the end of the pilot, the evaluation process identified the successes, benefits and challenges associated with the introduction of a paramedic role within the two practices.

All stakeholders involved in delivering the pilot, including practice partners, clinicians, managers and patients, identified that the service is adding value and having a positive impact in the following areas:

• Avoiding unnecessary attendance at A&E
• Supporting unplanned discharges and 111 reviews
• Reducing anxiety and stress for patients
• Improving patient satisfaction
• Releasing time for GPs to spend with patients, to complete additional education and to attend meetings
• Developing a contained see, treat and discharge caseload.

Time savings

Patient feedback
Feedback captured, through patient questionnaires, on the pilot’s benefits was very positive in both practices. There was a very high satisfaction with both the paramedic and their ability to provide care.

100% of patients rated their satisfaction with the visiting service as ‘very good’

100% of patients had a ‘high’ level of confidence in the care provided.

Patients felt that one of the main strengths of the paramedic role was that they were provided with support and management of their condition, which avoided a GP consultation or urgent/emergency attendance at their local hospital. Almost 50% of patients reported that without the paramedic visit they would have visited A&E, called 999 or called 111.

Next steps

The pilot, in particular the evaluation, was designed to help the practices determine whether use of paramedics was right for the needs of their workforce and their population. Through this process, one practice identified positive benefits and has made the role a permanent position within the practice. The other practice experienced some challenges during the pilot and the paramedic role was not continued.

The learning from the pilots has been documented within a summary report produced by Arden & GEM for the CCG and will be shared widely across the CCG/STP area.