Vince Baglole, Grayham Mclean, Kevin Crowther and Mark Townend
Welsh Ambulance Services NHS Trust (working collaboratively with the Western Vale GP Cluster and Cardiff and Vale University Health Board)
Background:
Calls from healthcare professionals place the biggest demand on the Ambulance Service in Wales, accounting for nearly 90,000 calls per year. Many patients are also often transported to A&E unnecessarily, when they could be safely treated at home – putting a strain on emergency services and the 999 system.
Aims:
The aim of this project was to use the assessment skills of a paramedic to undertake home visits to clinically appropriate patients on behalf of the GP, where previously the patient would have been transported to A&E by ambulance.
Following the clinical assessment, the paramedic would conduct a clinician-to-clinician conversation to discuss the findings. Based on the assessment and the GP’s knowledge of the patient history, the GP could make an informed decision on the most appropriate episode of care for the patient.
This project proved the concept of a system designed to enable paramedics to work within primary care. The data shows that when dispatched to clinically appropriate patients (i.e. ‘Green3’ calls), 90% of these patients can be managed at home and avoid admission to hospital by ambulance.
The project promoted collaboration by developing a multi-disciplinary team providing care to those most in need first. This leads to a reduction in unnecessary interventions and admissions to hospital. It also establishes a sustainable system of working, in which GPs can call upon paramedics to undertake home visits and assessments without accessing the 999 system.
Challenges:
Challenges of the project included the need to broker collaboration across many groups of healthcare professionals, and to encourage an entirely new system of working. These challenges were overcome by developing a multidisciplinary team who understood the aim of the project and worked together to ensure patients were receiving the most appropriate care in the most appropriate setting.
Outcomes:
Key outcomes of the project include:
- Patients are triaged as appropriate by the GP.
- Patients receive full clinical assessment in the community without the need for hospital admission.
- Acutely sick patients can be managed at scene within the paramedic scope of practice.
- Clinical decisions are made in consultation with the GP as the senior clinician.
- The GP has access to alternative pathways of care and appropriate clinical interventions as part of a multi-disciplinary collaboration.
- Patients receive the most appropriate care, from the most appropriate clinician, in the most appropriate place at the most appropriate time.
- Patient experience is improved through co-production, in line with the Prudent Healthcare principles.
Next steps:
The programme has proved the concept of paramedics working within primary care. This system change has been further developed in other parts of Wales to incorporate Advanced Practice into the multi-disciplinary teams within primary care.
The next steps are to scale and spread this project across Wales in collaboration with various Health Boards and the Primary Care sector. Although the original trial has now ceased, the concept has been taken up by Abertawe Bro Morgannwg University Health Board’s Out of Hours service and they are currently using paramedics to undertake home visits on behalf of GPs. This agreement is based on the original Bevan Exemplar Project
