Safely Reducing Avoidable Conveyance Programme

Leeds Paramedic Primary Care Rotation

Brief Description of Initiative

10 specialist paramedics undertook a 10 week rotation across 15 GP surgeries in Leeds from 4 June 2018.

The primary care rotation involved undertaking home visits on behalf on GPs and being part of the MDT primary care team which included a named GP mentor.

The specialist paramedics then rotated through the ambulance service emergency operations centre (999 control room) and front line paramedic duties.

Date Initiative was introduced in Trust

June 2018.

Date of upload or review

Uploaded to Repository 30 July 2020.

Background Context

In June 2018 Health Education England (HEE) funded a national pilot involving a number of ambulance services to pilot a model of rotational paramedics through primary care.

Yorkshire Ambulance Service formed part of this pilot and developed a model whereby 10 specialist paramedics (SPs) and 5 Advanced Practitioners began to rotate in groups in 3 groups of 5 clinicians across 15 GP surgeries in Leeds for 10 weeks, and then back into YAS where they would rotate between the Emergency Operations Centre (EOC) and frontline duties in a rapid response vehicle targeting appropriate 999 calls where they may be able to safely manage patients away from the emergency department.

Which specific patient group or presenting need is this response targeted at?
  • EOC (to support, dispatch to and advise to SPs on the ground)
  • A&E Operations – 999 calls
  • Primary care to complete some urgent home visits on behalf of practices.
Geographical area or location covered by this response model

Leeds.

Key Aims
  • The aims of the national pilot are to trial new models of working to support the workload across the wider NHS and send the most appropriate healthcare professional to the patient.
  • The main aims of the pilot are for Specialist Paramedics to rotate around the system more, which includes spending time working in a range of areas, such as GP practices and in different areas of YAS, such as our Emergency Operations Centre (EOC).
Benefits for Patients
  • Utilising specialist paramedics to undertake home visits earlier in the day will smooth the flow of primary care home visiting activity which typically occurs around lunchtime when GPs finish morning surgery. This in turn will smooth the surge in 999 HCP demand and ambulance conveyance to ED later in the afternoon.
  • Patients calling 999 should receive care by paramedics who have greater clinical decision making from increasing confidence and exposure to primary care.
Benefits for Trust or System
  • Improved confidence in decision making for paramedics
  • Improved performance within the 999 system as more patients are not conveyed
  • Improved staff retention as paramedics have role variation
  • Improved capacity across primary care
  • Greater understanding of roles across system as Paramedics and Primary care work together.
Implementation

1.     How long has this initiative been operational?

  • Since 2018-2019

2.     Days / Hours of operation:

  • Monday – Friday during primary care
  • Shift work for YAS

3.     Which clinicians are involved in the response and how many WTEs (if a specific cohort)?

  • Specialist Paramedics
  • 10 FTE

4.     Which other partners are involved in providing the response?

  • YAS
  • Leeds CCG
  • Leeds GP Practices (*15)

5.     What other key resources are needed for this response to work? (vehicles, specific equipment etc)

  • Unmarked lease car
  • Basic first responder equipment
  • Primary care diagnostics
  • Remote connection laptop and Mobile phone
  • Smart card for systemone access

6.     How is the initiative funded? (level of engagement/support from CCGs etc)

  • HEE funding and further funding from CCG
Evaluation & Monitoring

1.     What are the key success measures?

  • HEE evaluation report on national pilot
  • Staff views on paramedic rotation
  • Non-conveyance rates

2.     How are these being measured / collated / monitored?  (frequency / who reported to etc)

  • At final evaluation by HEE in their national report
  • At final evaluation by YAS after collecting CAD data on activity other metrics

3.     Has a formal evaluation process been undertaken (independent / inhouse)?

Yes, independent with HEE evaluation.

Internal evaluation completed which demonstrates significant improvement in non-conveyance rates for 999 post rotation.

4.     What are the current findings in terms of the success measures?

  • Non-conveyance rates improved for those individuals who rotated through primary care when operating back in 999 system, by on average 24% better than before their rotation began.
  • Primary care report more capacity in their system.
  • Mixed views from staff about whether they would want to continue to operate in primary care environment.
Sustainability

1.     Does the trust intend to continue with this response for the foreseeable future?

  • This model has been temporarily suspended due to a number of operational and financial pressures requiring consideration.  In addition, covid-19 pandemic has caused the review to be delayed.

2.     What long-term resourcing requirements are there?

  • Significant resources required if all PCNs identify a need for a rotating paramedic, YAS estimates that this could be an additional 150 SPs for each PCN within Yorkshire & Humber.
  • Significant investment and planning across the system, NSHE, HEE and HEI’s to develop workforce.

3.     What risks have been identified (for patients / trust / system) in providing this service and how have these been mitigated?

  • Some surgeries have since advertised and recruited their own paramedics as a result of their experience of the rotation, this poses a risk to ambulance service retention of staff.
  • Without robust system planning, there is a risk that PCNs will recruit their own paramedics instead of rotational opportunities, which will in turn place further pressure on ambulance service workforce retention.

4.     Is there potential to expand this response model?

  • Yes, however as noted above this requires good system planning in order to develop a model that is system wide.
Sharing & Learning

1.     What has the trust learnt most from introducing this process?

  • To ensure that early and close working with primary care occurs, as GPs don’t understand the skills and scope of a paramedic.
  • To work with PCNs early and make clear the expectations of paramedics and ambulance service as well as the expectations of primary care. It is important that ambulance services are not seen suppliers of staff to other organisations, but rather that all organisations are system partners.

2.     What might be done differently with the benefit of hindsight if implementing again? (in another part of the trust for example)

  • Greater planning with primary care partners so that GPs understood paramedics better before the rotation began which may have resulted in less resistance from some GPs. Most GPs were very receptive however.
  • Engaged with Research teams early to ensure that robust evaluation is planned from the start of the pilot discussions.
Additional Information

The effect of a specialist paramedic primary care rotation on appropriate non-conveyance decisions: a controlled interrupted time series analysis.  (Pre-print version; to be peer reviewed).

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