Background In response to rising demand for health care and limited availability of GPs, paramedics are increasingly working in general practices, most commonly to carry out home visits. UK policy supports this change which involves role substitution across professional groups and sectors of care. In Wales, schemes have recently been introduced with various configuration, employment and governance arrangements, but we do not know the risks and benefits of Paramedics working in Primary Care (PPC), or which model works best. As well as effects at individual patient level (safety, acceptability, and quality of care), this interface-crossing innovation may have an impact on service and workforce issues including efficiency, costs, professional role development, emergency ambulance availability and 999 response. There is an urgent need to better understand the PPC innovation. We aim to describe the evidence base, theoretical underpinning and current initiatives; and determine the feasibility of undertaking a definitive evaluation of PPC in order to produce generalisable evidence to inform policy and practice.
Method A survey of Welsh Health boards has been undertaken to identify sites and stakeholders to take part in qualitative interviews. We will conduct a feasibility study using a controlled before and after natural experiment design with three GP practice sites: one with a directly-employed paramedic; one with a Welsh Ambulance Service-employed paramedic; and a control site. We will collect the following outcomes:
Number of home visits requested
Home visit outcomes – the proportion resolved; further home visit required; emergency admission; 999 call placed
Subsequent health care contacts
Serious Adverse Events
Conclusion We will submit an application for a fully powered application to NIHR HS&DR if indicated by our progression criteria.
Results Welsh Health board survey and qualitative findings will be available at the time of the conference.
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