Summary
ARRIVE: Ambulance paramedics Responding to urgent patient Requests In general practice for home Visits – Evaluation development
Funder: HCRW
Background
More and more people are requesting urgent care, and there are shortages of GPs to see people who request appointments, in particular when patients are unable to get to the surgery. Paramedics are working in various roles in general practice including carrying out home visits in place of GPs. Initiatives have been set up across the UK involving paramedics in primary care – in some cases the paramedics remain in the ambulance service and are ‘on loan’ to the general practice, but may still answer life-threatening 999 calls. In other places, the paramedic is employed by the practice or group of practices and is no longer available to respond to any 999 calls. There is very little evidence about what works best, or even about what is happening in different areas. We do not know whether these initiatives are safe, acceptable to patients and carers or effective for the NHS. In addition, very little is known about any wider effects on the development of skills or roles, or about the impact upon delivery of emergency services.
Aim
We aim to provide an understanding of how and why paramedics are working in primary care, as well as the potential impact that this new model of delivering care may have on patients, NHS services and professional roles. We will assess whether we can carry out a full evaluation of this new model of care, and if so we will develop a proposal for a future UK wide study.
What we hope to discover
We will pull together existing research about paramedics working in general practice. We will also find out what initiatives are run by ambulance services and general practices across the UK. We will collect the views of people affected by this new way of providing care – paramedics, doctors, patients, carers and managers. Finally we will collect information from a small number of practices in Wales where paramedics conduct home visits instead of GPs. We will include practices where paramedics have been introduced and where they have not. We will collect data about numbers of home visits requested and how practices respond, patients’ health care contacts, patient satisfaction, adverse events and costs, to help us decide whether we can carry out a full evaluation of paramedics working in general practice in the future. If our results show that we can do this, we will develop a proposal for a larger follow on UK-wide study to assess whether these schemes are safe, acceptable to patients and carers, effective and efficient.
Public involvement
We have worked with patients and members of the public in an active PPI group to design this study. We have presented our initial ideas to an interactive meeting of the group and included feedback on the proposal. Two lay members are named as co-applicants and have been involved in iterative changes to the proposal. They will be involved in the study at all stages as full research team members, supported by a dedicated academic member of the team.
Dissemination
We will work closely with ambulance services, general practice networks and paramedic professional groups across the UK throughout this study. The research team has a strong track record of completing research in emergency and primary care and of disseminating work using academic, clinical, service, policy, and user-friendly routes to influence policy and practice and make the biggest impact.
Contact Details
Trial Manager / Lead Contact: Dr Mark Kingston
Phone: 01792 606844
Email: m.r.kingston@swansea.ac.uk
IRAS ID: 252193;