A new community focus for paramedics
Rural areas pose a particular challenge for emergency services. The North East Ambulance Service is taking a new approach in three areas of the region, with community paramedics working more closely with GPs and other healthcare staff.
Two new pilot schemes started in the summer – in Weardale and Berwick – and they join the one in Barnard Castle where the new way of working has just been extended for another year. All three are jointly funded with the local CCG.
Each of the schemes aims to:
- Provide improved access to community-based health care for patients;
- minimise the time taken to respond to life-threatening emergencies; and
- reduce the number of patients taken to hospital unnecessarily.
As well as the focus on patients, their aim is for NHS resources to be used more effectively. The paramedics need a minimum of two years’ registration and completed eCare training.
Weardale
The Weardale scheme covers Crook, Willington and Stanhope and will initially run for a 12-month trial period. The Berwick service was initially a three-month pilot but has now been extended for a further six months.
A team of paramedics use a rapid response vehicle and is available for 12 hours a day, seven days a week. They will work exclusively in the area and respond to category 1 calls if they’re the nearest resource.
Phil Blance, Clinical Operations Manager for the Durham Dales, said: “The Barnard Castle service has been running successfully for a year now. One of the main benefits has been to deliver a significant reduction in the number of patients having to be taken to hospital.”
After some initial hesitation across the NHS system, the service is proving popular among NHS staff and residents, including the local Patients’ Rural Group.
Good points
“It has led to more collaborative working in multi-disciplinary teams, including GPs, health visitors and falls teams. Working together means it’s a more structured and robust framework – we have a greater understanding of each other’s roles. For example we have a greater appreciation of what district nurses do. In turn they now realise we can provide 12-hour pre-hospital care and can respond to C1 life-threatening emergencies.
“We are also doing a lot more primary care work, going to see patients with long-term conditions such as diabetes and hypertension. We have 30 PGD drugs with us for the treatment of patients who have a number of lower acuity illnesses, to prevent them going into hospital.
Advantages
“There have been a number of benefits with the introduction of the new way of working.
- Our paramedics have a GP as a mentor, providing clinical assurances and assessments about the long-term conditions of patients.
- We are able to reduce the number off 999 calls and hospital admissions, especially helping those patients who call us frequently and those with long-term conditions. The use of the NEWS2 score has allowed us to assess patients before their condition deteriorates to the need for them to make a 999 call.
- Our paramedics also gain a better understanding of GPs’ work. As part of the scheme they spend one week in every three with a GP.”
One of the challenges Phil found in setting up the scheme was understanding the funding process and working with external stakeholders.
Berwick
Ruth Corbett, Clinical Operations Manager for North Northumberland, said: “Much of the work is carrying out visits to patients on behalf of GPs and district nurses. That frees up time for more GP appointments - in the time it takes a paramedic to see one patient at their home, a GP can see up to seven patients at their practice. That’s a huge win for the NHS and the Berwick community.
“It’s also about learning from each other and educating the multi-disciplinary teams when and when they don’t need an ambulance. For example, we used to get a lot of referrals from the Berwick Minor Injuries Unit when they needed a patient transported to an acute hospital – these always came to us a C2 transfers however this is not necessary when no treatment would need to be administered on route. That has reduced significantly with the introduction of the community paramedics into the unit.”
Benefits for NHS and town
The scheme has also significantly reduced the time it takes to respond to C1 calls in the area – from 12 minutes in June to seven in July and August.
“You’ve got to be a confident, autonomous paramedic, be able to have difficult conversations and diplomatically challenge other healthcare professionals.”
Apart from the minor injuries unit, the pilot also involves two GP practices in the town. Paramedics work three days in one and two days in the other, smaller practice from 9.30am – 6pm. Apart from home visits, they also go to local health clinics, care homes and participate in multi-disciplinary team meetings.
Each paramedic has a GP mentor and as part of the process of learning from each other, the paramedics have also delivered life-support training for GPs, following a request from doctors. They have also helped other healthcare staff deal with end-of-life patients who had set out their wishes for when they died in an advanced directive.
On another occasion, the paramedic flagged up a safeguarding issue to other colleagues a case where the family of an elderly patient with was being financially abused – this is partly due to the fact the paramedic can afford more time with the patient(s) than the GPs.
Ruth added: “Even some of our own colleagues, who were sceptical, say it’s made a massive difference in the area. I’m really passionate about supporting local people with our resources and this is an exciting opportunity for work more closely with local primary care teams.” I am pleased to say that the trust has managed to secure a further six months of funding to help us develop the role, and evidence the benefits to a wider audience and hopefully we can start to further develop the existing community paramedic roles we had in the trust.