Taking healthcare to the community: the evolving role of paramedics

Within paramedic unscheduled care, there has become a fixation on delivering urgent care provision to the patient. Whilst this has its roots in one very familiar Bradley Report (Department of Health 2006), the well quoted Keogh Report also sets out that ambulance services should develop into ‘mobile urgent treatment services capable of dealing with more people at scene, and avoiding unnecessary journeys to hospital’ (NHS England 2013: 8). In essence, delivering care to the patient. The accessible literature shows that across the World, community paramedic programmes follow similar notions. Canada (Reust et al 2012), Australia (Blacker et al, 2009) and certain states within the USA (Jensen et al, 2016) offer community schemes where paramedics work in collaboration with other community services to meet community-defined needs. Although differing in their individual approaches, the general principle is the same: paramedics are reaching out into the community to provide care which often reduces emergency department attendances and results in cost savings, both to the patient and the health provider (Nolan et al, 2012; Jensen et al, 2016). Some patients will always require care to be delivered to them due to various mobility, co-morbidity and access issues. Equally, many patients do not have these issues and are able to travel. What many current healthcare models do seem to miss, is the responsibility this report offers. Keogh explicitly states that the ‘report sets out some principles. How they are developed locally will, and must, vary to suit local circumstances and wishes. We will need different approaches in metropolitan, rural or remote areas. The majority of people needing urgent care do not have life threatening problems so we must focus our attention on bringing the best care to people as close to home as possible, wherever they live’ (NHS England 2013: 9).