Home visits from paramedic practitioners in general practice: patient perceptions

As set out in the General Practice Forward View (NHS England, 2016), the success of general practice will rely on new ways of working, including having a multidisciplinary workforce. The difficulties of recruiting GPs in the UK are well publicised nationally, and GP surgeries are now embracing innovative ways of managing the crisis in general practice (NHS England, 2016). The introduction of the role of the paramedic practitioner (PP) working within a GP surgery was proposed in a report by the Primary Care Workforce Commission in 2015 (Health Education England (HEE), 2015). Despite a rapid expansion of PPs in general practice, there is a weak evidence base regarding the role.

It is important to note that the PP has different titles across the UK such as emergency care practitioner (ECP). Moreover, individuals who call themselves ‘PP’ or ‘ECP’ may have entirely different qualifications and experience (Woollard, 2006). Unlike the standard ‘paramedic’, the title of PP is not registered with the Health and Care Professions Council (HCPC). All titles have been used within the literature search to ensure the retrieval of all available evidence. Therefore, as a result of the different training that PPs receive, the literature is not comparing like for like, which is important to acknowledge for the analysis of this work. PPs working in general practice should be trained to an advanced level to diagnose, treat and refer autonomously. There appears to be wide heterogeneity in the evidence regarding what the role of the PP in general practice involves, including no formal definition of scope of practice; however, a recently commissioned document from HEE (2019) sets out a core capabilities framework of what PPs should be able to do in primary care. Part of the role of the PP is to attend home visits, usually undertaken by the GP. Bird et al (2016) found that home visits make up 6% of GPs' workload, equalling around six visits per week per GP. This equates to a high number of home visits in large practices, where the PP may be more appropriate to send.