18 May 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.