View From the Ground, by Tracey Drozdziol
After 18 years of work in the Ambulance Service in patient transport, during which I rose to the level of emergency medical technician, I enrolled in a paramedic science degree at the University of Northampton. I graduated in 2017, and worked as a rapid-response paramedic for about a year. Towards the end of this period, I met a practice manager working with trainee GPs who asked if I would be willing use my skills as a paramedic for the surgery and, following a short recruitment process, I became part of the primary care team.
In 2018, the practice of paramedics joining primary care teams was relatively new—certainly in Bedfordshire, where I work. There was no clear guidance on how GPs should use my skillset or how the service should work. For this reason, I was employed on an 18-month trial across a cluster of six surgeries. Initially, there were many barriers to overcome with patients, as they wished to see a GP, not a paramedic; their perception was that I was attending to them as a paramedic, not as a member of the primary care team. I also encountered misunderstandings with some GPs about my clinical knowledge, as they were unaware of the level of detail involved in a paramedic’s education. I overcame these obstacles by actively working with patients and GPs—increasing patients’ understanding of my role, and enabling GPs to learn more about the skills paramedics have to offer.
In addition, there were no existing guidelines on how paramedics working in primary care should conduct home visits. Working with the surgeries and utilising my knowledge and experience as a paramedic, we established a protocol to better protect patients and paramedics conducting home visits as part of the primary care team. The act of creating this guidance also helped the GPs to gain a better understanding of my clinical and patient-assessment skills.
However, during this period, I felt as if I was still thinking like a paramedic in the Ambulance Service. I needed to learn more about primary care, and the gaps in the services offered by the surgeries that I could fill. The surgeries and I decided that I should undertake additional training to understand the needs of primary care as opposed to those of emergency care. This included courses in ear care, minor illness, and nonmedical independent prescribing. After completing this training and incorporating its teachings into my work with the surgeries, I have a better understanding of assessments and treatments in general practice. I am now responsible for referrals to GPs, and have developed a mindset more tailored to primary care.
Box 1 provides a case study that illustrates the difference in approach between a paramedic who is an emergency responder and a paramedic working in general practice.
|Box 1: Case Study|
A patient presented with shortness of breath, reduced mobility, swelling, and pitting oedema of the legs. After walking a short distance, the patient had to stop and take time to catch their breath. The patient had no history of respiratory or cardiac diseases. The patient was treated a week ago with antibiotics for cellulitis of the leg. At that time, the patient was observed to have an elevated BP and RR, but their pulse and temperature were normal. Upon auscultation, basal crackles could be heard, and their legs showed no evidence of cellulitis, but there was pitting oedema up to the calves.
As a Paramedic Working as an Emergency Responder:
I would convey the patient to the emergency department of the nearest hospital for further assessment.
As a Paramedic Working in Primary Care:
Given the patient’s observations, I reassessed them. The patient’s BP had remained elevated, but their RR had decreased. I auscultated their chest once more, and the basal crackles were still there. I looked at the medical records held by the GP surgery for further information. Following my examination and with a better understanding of their recent medical history, I treated the patient with a course of furosemide, and arranged a follow-up appointment within a week to re-evaluate their chest, BP, and legs.
The following week, the patient had improved—there was no longer oedema in their legs, nor crackles in their chest, but their BP was still elevated. I treated the elevated BP with an antihypertensive medication, and arranged for a second follow-up appointment in 2 weeks. The patient remained at home instead of being admitted to hospital—this was a better outcome for both the patient and the NHS.
BP=blood pressure; RR=respiratory rate
It has been a real learning curve coming from the Ambulance Service into general practice. However, it has given me a better understanding of, and a closer working relationship with, my primary care colleagues. I feel that my contribution to the primary care team has led to improved patient outcomes. It has also helped to save time and resources for ambulance services and emergency departments.
As clusters of GP surgeries transition into primary care networks,1 more paramedics are being recruited to start the journey I began in 2018. The GP surgeries that I am attached to have recruited a further two paramedics, and an Emergency Medical Technician, to continue delivering enhanced care to patients.
Paramedic, London Surgery working in partnership with Putnoe Linden Rd Surgeries East PCN, Bedford