Paramedics working in GP surgeries help reduce GP workload but do not contribute to cost savings to the NHS, according to the first major study of the clinical and cost-effectiveness of paramedic compared with GP consultations.
The study, jointly led by researchers at the University of Bristol and University of the West of England, and funded by the National Institute for Health and Care Research (NIHR), is published today [28 February] in the British Journal of General Practice (BJGP).
Findings from the two-year evaluation study, which included 715 patients and 34 GP surgeries across England, showed that although paramedics could reduce GP workload, savings to the NHS were offset by patients' higher use of other (non-GP) healthcare professionals in the 30 days following initial consultation, including repeat contacts with paramedics.
The study also found that there were no differences (neither improvement nor deterioration) in patient-reported experiences and outcomes after 30 days across a range of measures, including patient-reported health and wellbeing, confidence in health provision, health knowledge, and confidence in health plan, compared with GP consultations.
However, patients seen by paramedics reported lower confidence in health provision, poorer perceptions of practice engagement in safety promotion and more communication problems with staff immediately after the initial consultation. Researchers recommend further work is required to understand whether this reflects specifically the care provided during the initial paramedic consultation or broader issues in primary care.
The 34 GP surgeries that took part in the study were from a mix of urban, rural, deprived, and affluent areas, ensuring a diverse representation of general practice sizes and populations. This included 25 practices with paramedics and nine without. The 715 patients who took part completed a questionnaire after their initial consultation, with 489 also completing a follow-up questionnaire 30 days later. Questionnaires assessed patient experience, outcomes, and perceived safety, quality of life, and healthcare use.
Dr Matthew Booker, a GP and Consultant Senior Lecturer in Primary Care at the University of Bristol's Centre for Academic Primary Care, and one of the study's lead authors, explains: "There has been a three-fold rise in the use of healthcare professionals such as paramedics over the past five years to help tackle the significant pressure general practice services are facing owing to increased healthcare demand. Consultations have been rising by up to 15% annually, costing the NHS £9 billion, with a shortage of GPs to meet demand. Paramedics are increasingly working alongside other members of the general practice team, managing minor illnesses, conducting home visits and providing urgent consultations among other roles.
"While our study suggests that paramedics can play an important role in general practice, easing GP workload and providing clinically effective care to patients, we have found no evidence that their use is cost saving for the NHS. Well-designed training and supervision are needed to ensure paramedics have the right knowledge and can clearly convey healthcare plans to patients."
Sarah Voss, Professor of Emergency Care at the University of the West of England, said: "Our study is an important first step in understanding the impact of paramedic consultations on patient experience, safety and costs. Further research is needed to see whether our findings can be replicated in other primary care settings and to plan how paramedics are deployed, trained and supervised so they can quickly gain the trust of patients that they see."
The research team has produced a range of materials for both patients and professionals, drawing on findings from the READY Paramedics study. These include an interactive toolkit for practices to determine how best to configure their services involving paramedics, videos explaining the idea of paramedics in general practice and key messages from the study, and template patient information leaflets about the role of paramedics in primary care.
Paper
'Paramedic or GP consultations in primary care: prospective study comparing costs and outcomes' by William Hollingworth, Nouf S Gadah-Jeynes, Hazel Taylor, Kirsty Garfield, Sarah Voss and Matthew Booker published in the British Journal of General Practice.
