A paramedic’s move to general practice

I worked as a Paramedic for the East of England Ambulance service for seven years before taking a post in primary care. My decision for this move was spurred mainly due to my growing interest in medicine, but I also felt that my development as a medic would benefit from the diversity of general practice.

Initial discussions with the partners of exactly how I would integrate into general practice focussed mainly on home visits and minor illness. But we were realistic and knew it was a role which would grow organically and need to prove its viability and ‘fit’. The phrase ‘leap of faith’ was aptly applied to my decision to leave the ambulance service to enter primary care as an Urgent Care Practitioner.

It wasn’t an easy transition for me or my new colleagues. I was used to working autonomously in the delivery of acute medical care with a defined scope of practice. My ambulance colleagues knew my capabilities by the very nature of my clinical grade. In contrast, the parameters of my primary care role were not set. Furthermore, few surgery staff (or patients) had experience of working with a paramedic.

The transition period

The first 6 months were a humbling period for me, and the learning curve was incredibly steep. But crucially I proved that my clinical knowledge and practical examination skills were at a level conducive with general practice (albeit at entry level). These provided the foundation of my new clinical role and an intense experiential learning period followed.

I was really surprised by the quantity of patients seen during the day and the complexity of their problems. There is so much to consider from medication interactions, side effects and diagnostic investigations.

Having the opportunity to re-examine a patient to determine the effectiveness of treatment was a foreign aspect. This took time to get used to,  I was used to ‘flash’ treatment period, with a handover to ED staff or referral. Typically a consultation is ten minutes- this is an incredibly short amount of time to be thorough. Although I am afforded slightly more time, it’s amazing how many people come with more than one complaint- and this is difficult to manage in a restricted timescale.  The responsibility in GP is far greater as there is so much more to consider.

An early observation made by my colleagues was my ability to make autonomous decisions, this was especially evident when dealing with walk-ins and admitting patients to hospital. We discussed this dynamic during supervision and identified decision-making as a key trait of an effective paramedic. This skill easily migrates into general practice. 

Having the benefit of a clinical educator ensured structured learning and I spent many sessions with the GP registrar and first year medical students on a placement. The latter afforded the opportunity to teach (informally) which I feel is important for any healthcare professional.

Two years on and my role is well defined and appreciated by surgery staff. We have proved the viability of paramedics in general practice and are planning for the next stage of development to ensure its sustainability.

I work on-call everyday and see patients at home or in surgery this follows the morning triage period. There is always a duty doctor (DD) working with me on-call which is essential for advice, teaching and/or onward referral (not to mention clinical governance). Because of this, the interaction between myself and DD throughout the day is continuous, this has been one of the crucial factors to the success of my role. Most pertinently, it has ensured clinical safety and allowed medication to be prescribed. I currently supplementary prescribe only.

Integrating more paramedics into general practice

I see more paramedics taking roles in GP. This is not only due to a shortage doctors- but also because the role of the paramedic is morphing. There is more onus placed upon training in minor illness as well as exposure to trauma (the traditional paramedic’s role).

The crucial factor to the sustainability of paramedics in GP is the granting of the licence to prescribe independently (or obtaining a MA/MSc integral Independent Prescribing). Health Education England have previously denied applications to achieve this, but it is hoped that as the role develops, they will reconsider and grant the license.

Advice for paramedics considering a move to GP

GP is not for everyone. Firstly be prepared for a dramatic change from near complete autonomy as a paramedic to a role more conducive to that of a foundation year 1 doctor.

Year one is especially intense as you will be exposed to a host of new examination and diagnostic skills, whilst learning about medication.

Despite not working shifts or weekends, do not expect to be home on time every night!

And for a practice considering employing one

Appointing the correct candidate is key. They must have the under-pinning basic grasp of medicine and willingness to learn in greater detail. Respecting the limitations of their new role is essential for patient safety and self-governance.

Supervision, structured learning and mentorship is essential, if the practice is unable to deliver this, then I would advise against employing a paramedic.

Most paramedics are educated to degree level, which presently does not enable them to under-take an Independent Prescribing module (Level 7 MA/MSc). Practices may want to up-skill their paramedics to give them greater autonomy and prescribing capability.

Andy Watts, 42, graduated in Emergency Medical Care DipHe from The University of East Anglia.

He worked as a Paramedic for the East of England Ambulance Service for 7 years. During this time he worked on ambulances and solo rapid response vehicles. He was involved in clinical education and mentorship of student paramedics in the latter years of his career.

Two years ago, Andy left the ambulance service to take a new post in general practice as an Urgent Care Practitioner, where he continues to work.

As Paramedicine Champion of the University of Suffolk, he is actively involved in developing the role of paramedics in general practice.

He remains a member of the College of Paramedics.

  • Will Branagh
    Posted at 09:22h, 20 May Reply

    Your article rings very true for my own experience, 14 years in the ambulance service as IHCD tech then Para, with Para dip some years later, Jan 15 left the service to take up a role as a walk in centre practitioner and have never looked back, colleagues very impressed by history taking skills, have developed my physical examination skills and been provided opportunity to study modules at level 6 and 7.
    Still proud to be a Paramedic and have succeeded in attempts to secure my service as a clinical placement for the student Paramedics studying at the northwest universities..

    It’s very rewarding being able to assess, draw up treatment plans and actually discharge patients, the frustration is with being limited to PGD’s and even that was a battle with the skills and knowledge of Paramedics not being recognised within my trust, something that has now changed!

    It’s very refreshing knowing the vast experience and broad knowledge base Paramedics carry is finally being recognised by the wider NHS

  • Pearl Jolly
    Posted at 08:42h, 15 June Reply

    Post-Grad Diplomas for Practitioners with Special Interest – Level 7
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    Students are typically GPs who wish to specialise as a GPSI and Nurse Specialists in community and acute roles, who are required to work at a higher, more autonomous level and also where services are looking to be more innovative to meet local need.

    This year we have had our first paramedic apply.

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    • Russell Murray
      Posted at 07:41h, 17 July Reply

      Hi Pearl

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  • Ann Ball
    Posted at 10:12h, 02 August Reply

    Hi Andy
    that reads just like my experience over the last 9 months, cant believe the time has gone so quickly, i left a university teaching and course leader post to come back to practice and really it was the best move. Just a pity this opportunity didn’t arise after completing my ECP degree in 2005. All experiences i have had since then have really helped in practice, but again still a steep learning curve in those first 6 months, but as you i am told i sell myself short, and actually am an asset to the surgery, i just see it as doing the job they are paying me for. The surgery has a 10k list with a very multicultural feel so the patients keep me busy, and some even now request to see me, and as you say although i get a little longer at 15 mins – they do try to bring more than one thing to the surgery and also have complex underlying issues that need addressing too. I just hope that prescribing is passed this time and i will be one of the first banging the door to get a place on the course – cant wait 🙂

  • Ron Wilkinson
    Posted at 10:40h, 29 October Reply

    Hi Andy, Ann
    Just to say great article . I have recently started as a UCP in a busy York GP Practice 40k patients on the list.

  • Toby Marshall
    Posted at 11:50h, 04 March Reply

    Hi andy,

    Moving from the ambulance to paramedic practitioner job in a gp practice in london. Could you give any advice into a paramedic moving into a gp practice???



  • Billy Gibson
    Posted at 12:00h, 20 June Reply

    Just read this report/experience regarding working within GP surgeries..

    I initially when qualified in actue illness and minor injuries was exposed to primary care working within GP out of hours- working alongside experienced senior GP partners, ex surgeons, orthopaedic nurses, practice nurses… Wow it was such a steep learning curve, however, it was so enjoyable, everyday, assimilating soaking up others experiences, throughout that time I felt privileged and honoured to be accepted as a key member of the team. After 5 years I decided to go alone and promote my skill set via other agencies, to my surprise I found myself in demand working primarily within England (I may say I am from Scotland) therefore over the past 8 years I have had the opportunity to work and enhance my knowledge in many settings ranging from Walk in Centre, Primary Care Centres, Urgent Car Centres, Accident and Emergency Departments, GP surgeries

    Now that prescribing is eventually coming to Paramedics it can only be a step forward for all clinical settings as stated above. So I would advise any Paramedic to move forward and enhance their skill set, it will make you more viable within many settings in the future.

    So seaze the opportunity, but remember it’s certainly a culture shock moving to primary care, but you have so much to offer!!

    The only sore point regarding my situation despite my skill sets and experience is that in Scotland over the recent years have not been exposed to the skill set that a Emergency Care Practitioner has to offer.

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