References
Paramedic-led acute home visiting services in primary care
Abstract
Home visiting is traditionally carried out by GPs but it is becoming increasingly difficult for GPs to do, and many doctors want it removed from their contract. This is opening up a space for the paramedic profession, with paramedics carrying out home visits and designing future primary care services. Paramedics working within primary care can possess the knowledge, leadership and complex skills needed for home visiting, and some are independent prescribers; they can lead acute home visiting services (AHVS). AHVS require effective triage and access to electronic patient records, are underpinned by robust clinical governance and engage in clinical audits. Future primary care paramedic services could include online, video and face-to-face consultations, care home ward rounds, remote triage and home visiting. However, paramedics' contribution to general practice has not been fully evaluated and it may take time for this to become a norm. Regardless, primary care paramedicine has an opportunity to be innovative, shaking off risk-averse protocols for more enlightened practices, and lead the profession.
Home visiting is an unpredictable activity with an unknown outcome for health professionals. Ferguson (2018) states that home visiting constitutes a distinct sphere of practice and experience in its own right, as it is a deeply embodied practice in which all the senses and emotions come into play; practitioners apply home visits by skilfully enacting a series of transitions from the office to the doorstep, then into the house, where complex interactions with service users and their domestic space occur. Winter and Cree (2015) relayed the idea of home visiting as an ‘invisible trade’, as it happens behind closed doors in the most secret, intimate spaces of people's lives.
An advantage of home visiting is that practitioners witness patients' first hand in their own innate surroundings, which can uncover health and social care needs of ill and vulnerable people. Home visiting discloses many aspects of people's way of life and can stimulate wider thought processes for practitioners in comparison with consulting in the static confinement of hospitals or medical centres.
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