Understanding the role of the paramedic in primary care: a realist review

Abstract

Background Since 2002, paramedics have been working in primary care within the United Kingdom (UK), a transition also mirrored within Australia, Canada and the USA. Recent recommendations to improve UK NHS workforce capacities have led to a major push to increase the numbers of paramedics recruited into primary care. However, gaps exist in the evidence base regarding how and why these changes would work, for whom, in what context and to what extent. To understand the ways in which paramedics impact (or not) the primary care workforce, we conducted a realist review. Methods A realist approach aims to provide causal explanations through the generation and articulation of contexts, mechanisms and outcomes. Our search of electronic databases was supplemented with Google and citation checking to locate grey literature including news items and workforce reports. Included documents were from the UK, Australia, Canada and the Americas—countries within which the paramedic role within primary care is well established. Results Our searches resulted in 205 included documents, from which data were extracted to produce context-mechanism-outcome configurations (CMOCs) within a final programme theory. Our results outline that paramedics are more likely to be effective in contributing to primary care workforces when they are supported to expand their existing role through formal education and clinical supervision. We also found that unless paramedics were fully integrated into primary care services, they did not experience the socialisation needed to build trusting relationships with patients or physicians. Indeed, for patients to accept paramedics in primary care, their role and its implications for their care should be outlined by a trusted source. Conclusions Our realist review highlights the complexity surrounding the introduction of paramedics into primary care roles. As well as offering an insight into understanding the paramedic professional identity, we also discuss the range of expectations this professional group will face in the transition to primary care. These expectations come from patients, general practitioners (family physicians) and paramedics themselves. This review is the first to offer insight into understanding the impact paramedics may have on the international primary care workforce and shaping how they might be optimally deployed.

Potential for Paramedic roles in Irish General Practice: A qualitative study of stakeholder’s perspectives

“…The wider literature does highlight potential antagonism towards new Paramedic roles in Primary Care but suggests that this can be resolved through exposure, familiarity, and the clarification of scope of practice from the outset 8 , 46 , 47 . The importance of full integration with the primary care workforce has been identified as a key feature of successful models of Paramedic working in primary care 21 . The interface of GP, Practice Nurse, Paramedic and other Primary Care Staff warrants ongoing consideration.…”

“…While entry level Bachelor of Science degree qualifications have been introduced, they are not yet a requirement for professional registration. Until recently the role of Paramedics and Advanced Paramedics in Ireland has been exclusively focused on emergency care, however a recent pilot project has explored the feasibility of ‘Community Paramedicine’ where Paramedics operate in expanded primary care roles within the ambulance service 21 .…”

“…The ‘Community Paramedicine’ development in Ireland mirrors international developments in paramedicine. A number of recent reviews have detailed the evolving role of paramedics in the delivery of primary care through collaborative partnerships with general practitioners, practice nurses and multidisciplinary teams, aimed at providing care in the community closer to home 21 – 23 . This is particularly true where paramedics provide access to primary healthcare in settings where it would otherwise not be available or delayed, such as in rural and isolated communities, and with populations that have historically faced barriers in accessing healthcare, such as those experiencing homelessness 21 , 24 .…”

“…A number of recent reviews have detailed the evolving role of paramedics in the delivery of primary care through collaborative partnerships with general practitioners, practice nurses and multidisciplinary teams, aimed at providing care in the community closer to home 21 – 23 . This is particularly true where paramedics provide access to primary healthcare in settings where it would otherwise not be available or delayed, such as in rural and isolated communities, and with populations that have historically faced barriers in accessing healthcare, such as those experiencing homelessness 21 , 24 . Paramedics have already undertaken roles in primary care assessment and onward referral, health promotion, vaccination, chronic disease monitoring and management, palliative care and urgent primary care 23 .…”

Identity, positionality and reflexivity: relevance and application to research paramedics

“…A recent global Delphi study provided a definition of paramedicine, which acknowledged paramedics’ specialist skillset and wide range of potential working locations ( Williams et al, 2021 ). Despite this variety, paramedics – including student paramedics – have been found to have a strong and positive image of their professional identity ( Eaton et al, 2021 ; Johnston & Bilton, 2020 ; Lloyd-Jones, 2015 ).…”