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04 Paramedic perspectives towards gp referral schemes in north west england: a qualitative-observational study
  1. Joanna Blodgett1,
  2. Duncan Robertson2,
  3. David Ratcliffe2,
  4. Kenneth Rockwood3
  1. 1North West Ambulance Service NHS Trust (NWAS) and University of Manchester Institute of Brain, Behaviour and Mental Health
  2. 2North West Ambulance Service NHS Trust (NWAS), UK
  3. 3Geriatric Medicine Research Unit, Dalhousie University and Centre for Health Care for the Elderly, Canada


Background An innovative policy developed and implemented by a UK Ambulance Service allows paramedics to refer patients to the GP Acute Visiting Service scheme. Initial evidence suggests that using this alternate route of care can decrease hospital admission rates, increase bed availability, decrease wait time in A and Es and provide substantial savings for the NHS. However, there are many unrecognised barriers to referral that have not been 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.

Methods We observed eight paramedics throughout full shifts of 8–12 hours. Data was collected using participant demographics, researcher observations and informal semi-structured interviews. All notes were transcribed, coded and analysed using a Grounded Theory approach to identify emerging themes.

Results Paramedics expressed a wide range of frustrations with the scheme, identifying the waiting time, the process and a lack of confidence, experience and training as the three major barriers to referrals. They described how they approached patients with the GP referral scheme in mind, identified common characteristics of referrals, described how the triage tool shaped their decision making and shared how they involved the patient in the decision making. They shared too their frustrations with some GP decision making, which they admitted then influenced their future decision making. Finally, they described what motivated them to refer and discussed the lack of awareness and understanding of the scheme’s impact and aims.

Conclusions 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.

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