Abstract
Background
Global primary care is facing unprecedented staff shortages and rising demand for patient care.
A skilled non-medical workforce is fundamental for optimising workforce resources and
meeting global population health needs. In 2018 UK policy changes granted paramedics
independent prescribing (IP) rights providing opportunity to enhance advanced practice (AP)
skills and workforce flexibility.
Aim
To explore how paramedic IP is adopted and implemented to support general practice in
England.
Methods
A two-phased, mixed methods study: Phase 1 (2019) a cross-sectional survey of the paramedic
AP workforce (n= 234), Phase 2 (2021) a multiple case study of four primary care providers
with paramedic IP services, comprising mixed-method consultation activity (n=246), patient
satisfaction questionnaire (n=61) and qualitative team interview data (n=16).
Results
Phase 1; 68% (n=160) of AP paramedics were engaged in medicines management activities
and were predominantly based in non-ambulance, primary care settings. GPs were involved in
73% (n=1667) of medicines management decisions due to lack of prescribing rights. Phase 2;
92% (n=225) of paramedic consultations were unscheduled same-day with prescribing
decisions made in 63% (n=154). Patients expressed satisfaction with paramedic led care (mean
Consultation Satisfaction Score 75.4, SD 14.3) with 94% (n=57) agreeing that paramedics
should have prescribing capability. Implementation facilitators were pro-IP visionary
leadership, strategy and secure funding. However general practice lacked strategic planning to
maximise paramedic IP roles and ensure their long-term sustainability.
Conclusion
The primary care paramedic IP role was highly acceptable to staff and patients across all
participant sites and few barriers impeded early implementation. This model of care has
important UK and international implications for maximising primary care workforce resources
and providing a more flexible and accessible model of service delivery. To fully realise the
contribution of paramedic IP in primary care, further evaluation of the safety, appropriateness,
cost-effectiveness and long-term sustainability is required.