References
Creating a safety net for patients in crisis: paramedic perspectives towards a GP referral scheme
Abstract
An innovative policy implemented by a UK Ambulance Service allows paramedics to refer patients to a GP Acute Visiting Service scheme. Initial evidence suggests that this alternate route of care can decrease hospital admission rates, decrease A&E waiting time and provide substantial savings for the NHS. However, there are many unrecognised barriers to referral that are not captured by the quantitative analysis. The goal of this qualitative-observational study was to gain insight into the GP referral scheme from a paramedic's perspective. All notes were transcribed, coded and analysed using a Grounded Theory approach. Four main themes emerged: 1) barriers to referral including wait time, process, and lack of confidence, experience and training 2) approaching the patient with the GP referral scheme in mind 3) frustrations with GP decision making and 4) awareness/understanding of the scheme's impacts. This study provided valuable insight into the paramedic's perspective of the GP referral scheme. Maximising understanding of the scheme, investigating the GP's perspective in decision making and ensuring knowledge and accountability of paramedics, GPs and the public were identified as solutions to strengthen and increase referral rates and scheme success.
The scope of practice for paramedics has expanded considerably over the past few decades. Fifty years ago, the main role of an ambulance service ‘driver’ was to transport the patient to the hospital as quickly as possible, with little to no medical intervention (Palmer, 1989; Bergman, 2007). With continuously expanding and integrative health care systems, it is not necessary, feasible, nor sustainable to convey all patients directly to hospital. Education and training have given paramedics more scope to assess and determine if the patient needs Emergency Department (ED) care. Despite this, the number of emergency calls continues to rise (Health and Social Care Information Centre, 2015). With a rise in calls come greater ED delays, and reductions in bed availability (Imison et al, 2012). Consequently, paramedics are increasingly expected to safely and efficiently divert patients away from hospital.
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