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College of Paramedics: My role as a
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My Role as a Paramedic in Primary Care
Gary Strong MCPara, National CPD Lead,
chats to Simon Robinson MCPara, Advanced Clinical Practitioner, Paramedic, Partner at Beacon Medical Group in Devon.
Gary: Si, how did you first get the idea to work in primary care? What got you started?
Si: I’ve always looked for challenges throughout my career, whether it’s working as a Royal Marines commando paramedic managing trauma in Afghanistan or working as a paramedic practitioner within the emergency department. It was in 2015 during a home assessment for a frail elderly couple with many medical and social needs. I was working as an Emergency Care Practitioner (Specialist Paramedic) for SWAST. I ended meeting an innovative GP who liked the autonomous practice and holistic care being provided. He offered me a job to do the same role but with greater opportunities to develop further with support and mentorship. Beacon Medical Group would allow me to use greater levels of autonomy and increase my scope of practice and push the boundaries of my profession. I would have greater input in patient care through diagnosis, treatment, and recovery.
Gary: What were the biggest challenges you faced in your first few months in this new environment?
Si: We did not know how to indemnify my practice. We spoke with numerous insurance companies and professional bodies and the regulator, HCPC. We asked the College of Paramedics, the General Medical Council and even had a ‘Pulse’ journalist research paramedics in primary care but we could not find any other primary care providers who employed a paramedic within the UK at that time. With regards to training and development there was little in the way of useful structure or frameworks available, so we developed our own (still used today).
Additional challenges included other health care providers and staff not understanding the versatility of the paramedic and, still the need to address the misconceived idea that paramedics were just ambulance drivers. We kept hearing phrases like ’you can’t do that, you’re just a paramedic’. We also had issues with secondary care refusing referrals. We launched a campaign with a nurse practitioner and pharmacist about the advantages of right care, right place, right time and I have spoken multiple times at the national best practice conferences about my role which was seen as a catalyst for paramedics within primary care.
Gary: I believe the practice fairly rapidly identified you as its resuscitation lead, which seems a good use of a paramedic to me. How did that work out?
Si: This was good for me as a former lecturer practitioner at Plymouth University where you and I first met. It meant that I could keep my teaching up-to-date and it saved the practice money by arranging training ‘in house’. It was especially useful to create realistic primary care scenarios to make the learning authentic. I’ve since handed the role over to one of our ACPs (also a paramedic) but I’m still keen, when time allows, to get involved.
Gary: Tell us about your educational role in the practice and how that developed.
Si: Initially, I thought this role was to keep me quiet(!), however this was before Health Education England (HEE) had really addressed the issue of paramedics working at an advanced level in primary care. We created our own developmental framework for the urgent care team.
This unifies our team of paramedics, physiotherapists, nurses and a paediatric nurse working at the advanced level. My aim was for the practitioner to follow the same development framework allowing for differences in training and backgrounds but to keep their professional identity. This was linked to HEE recommendations but designed specifically for primary care and recognising all healthcare professionals working at the advanced level in a simple format.
Currently, we are also supporting 18 undergraduate paramedic students with placements, showing them the diversity of presentations encountered and skillsets needed for primary care. I have also designed and implemented training courses including paediatric fever courses supporting efficient, safe patient management.
Gary: What do you find most rewarding about your role?
Si: The variety of the role and patient presentations of all ages. There is always something new to learn. Primary care undertakes 90% of all NHS work but receives 10% of the budget. It has been a really tough last couple of years. There has been 85% changeover of my team with some of our staff returning to the ambulance service and secondary care due to the stresses and workload. At times, I’ve found it the most stressful job, beating all previous roles. Primary care is not for everyone.
However, putting a new multi-disciplinary team together and supporting their development is really rewarding. It’s great to see them grow as individuals and the team grow in confidence. You wouldn’t pick a rugby team full of scrum halves and expect the team to play well… this diversity of background really does work. I have a highly-motivated team with a multitude of experiences gained from their various backgrounds and professions.
Gary: You have recently become a practice partner. How did that come about, and what difference has it made to your working life?
Si: I was asked, then voted in by the other partners. As mentioned, Beacon has a very contemporary outlook and the partnership wanted other professions as partners as well as GPs. I have always been keen to push the boundaries to influence positive change to improve service delivery. I try to use my enthusiasm to help support others within the group and externally supporting with ACP and team development as an example.
My team manages around 30% of the practice’s daily contacts. I am passionate about how, as a team we manage patients and support with patient flow. This is reflected in our low emergency department admission rates due to our improved access to triage and treatment abilities via the phone, text or e-consults. Being a partner is a huge commitment as along with the other partners I share responsibility for 200 staff and the provision of health care for approximately 43,000 patients. It will allow me to have a greater input in shaping our work force to meet the needs of the local population.
Gary: This seems like an exciting time for paramedics in primary care. What do you think the future might hold, and what kind of leadership skills do we need to develop as a profession in primary care?
Si: The profession is so universal now. As generalists, with the right support and development, we can turn our hands to most health care needs. Within primary care we have paramedics learning to run joint injection clinics, minor surgery clinics, women’s health clinics, paediatric clinics and much more. These are exciting times to be a paramedic in primary care.
The opportunities are endless. I was once told: ‘A paramedic in a GP surgery? This won’t work, you will never be able to prescribe for a start’. We need to keep pushing forward and challenge legislation that holds us back. Don’t be afraid to say ‘Why? I can do that’. Push for courses such as prescribing. Volunteer to project manage and take ownership.
Gary: What would be your advice to any recently registered paramedics who are keen to work in the area?
Si: Use the four advanced practice pillars as a framework towards development. Learn about the potential next stages of patient care after your assessment. Manage risk and treat the patient. Do not attempt to ‘shoehorn’ patients to guidelines. Get placements in primary care, this role is not for everyone. Make sure any job opportunities come with training and development and check the versatility of the role and support being offered.
Gary: Thank you Si.
