Ambulance services are helping to relieve GPs’ huge workloads by using some of their paramedics to carry out home visits to sick patients, a service traditionally undertaken by family doctors.
Paramedics are swapping answering 999 calls for tending people who have asked for a GP to see them at home because they are too ill or frail to come into the surgery.
NHS bosses say paramedics taking on this role is fast emerging as a way of helping GPs, stopping patients ending up in hospital unnecessarily and tackling chronic understaffing.
The North East ambulance service (NEAS) is one of several services that is seconding paramedics to work with GPs because they believe that home visits help the NHS overall, including reducing pressure on A&E, which is experiencing record demand for care.
“It helps GPs, patients like it and paramedics enjoy working like this,” said Paul Younger, who has been with the NEAS since 2002 and is one of its six paramedics who work in primary care.
“It takes about 45 minutes for a GP to go and see a patient for a home visit. But they can see four to five patients in their surgery in that time if a paramedic does the home visit instead.
“Plus, we paramedics can get there quicker, sometimes in as little as 15 minutes, whereas if a GP was going to visit someone at home who’d rung the surgery that morning, they’d have to wait until they’d seen all their patients that morning and then go, so not until lunchtime.”
Three NEAS paramedics work like this every weekday around Berwick, and another three in North Tyneside, including Whitley Bay, North Seaton and Wallsend. They drive unmarked cars rather than NHS ambulances.
“Initially, some local GPs were a bit dubious. GPs have been doing primary care for decades so, with the change, some thought: do the paramedics know what they’re doing? Are patients safe? But over time they’ve learned that they can play an important part of looking after patients in primary care,” added Younger.
Almost all the patients he and his colleagues visit are housebound. Most referrals have come from a GP but sometimes a district nurse, care home or domiciliary care worker makes the request. The NEAS paramedics also cover care homes – they comprise one in seven of their visits.
“The range of clinical cases paramedics deal with is vast,” said Paul Aitken-Fell, NEAS’s lead consultant paramedic, who set up the service in 2019. The most common problem they encounter is trouble breathing, for example because of chronic obstructive pulmonary disease. But they deal with a wide range of conditions including joint pain, skin problems, infections and heart attacks.
“If you are having a heart attack you’d be better off with a paramedic turning up at your house than a GP because, being specialists in urgent and emergency care, we see them more than GPs,” added Younger. Only one in 10 patients ends up going to hospital because paramedics’ experience means they can treat most of them on the spot and draw up a care plan, sometimes with input from a GP.
NEAS is in talks with GPs elsewhere on its patch to start providing the service, including Hartlepool and Easington, said Aitken-Fell. NEAS’s ability to deal with 999 calls is not undermined by the scheme because the six are dedicated home-visit paramedics, and deploying them like this should ultimately cut the number of people needing a blue light ambulance, he added.
“This is a great example of different parts of the NHS coming together and working in new ways to deliver better care for patients,” says Saffron Cordery, deputy chief executive of NHS Providers, which represents England’s NHS trusts, including the 10 specialist ambulance trusts. “It’s a win-win-win: for the organisations involved, for staff and above all for patients, who feel listened to, safe and confident in the care provided.”
NHS Providers has highlighted NEAS’s work with GPs in a report to be published this week on the creative solutions that trusts are adopting, given the health service in England is short of almost 100,000 staff.
Several other ambulance services offer GP-style home visits. London ambulance service paramedics have undertaken home visits and worked in GP surgeries in the boroughs of Redbridge and Merton since last year.
LAS is expanding its efforts to help hard-pressed GP surgeries. Thirty of its paramedics are currently on a training course, in conjunction with Health Education England, to enable them to work in GP surgeries alongside family doctors, practice nurses and their colleagues.
“Arrangements like this are proving to be a virtuous circle where everybody benefits. We must expand these schemes to help keep primary care sustainable,” said one NHS boss.
