High Integration, Medium Complexity example

A medium sized, urban practice with mixed demographic of young families, working age adults and very few care/residential settings. The practice is a member of a PCN of varied practices, and currently has a higher than average ‘on the day’ demand. The practice GP and nursing workforce is stable. The practice manages a high proportion of same-day contacts through clinical navigation, has a higher than average ED visit rate, and still struggles with same-day capacity. Chronic disease work is largely to target, managed capably by a stable and experienced practice nurse team.

A paramedic is directly employed by the surgery to work full time at the site. The paramedic works as part of the same day ‘urgent care team’ in the practice alongside two Advanced Nurse Practitioners in a similar role, seeing predominantly same-day minor illness and urgent health needs. The paramedic is completing a non-medical prescribing qualification and is mentored day-to-day by one of the very experienced ANP prescribers. Prescribing will be a welcome addition to their skillset, as needing to task a GP to prescribe is currently time consuming and results in some interruptions to the flow of duty surgery, and duplication of effort. The paramedic role includes triaging and conducting a high proportion of remote/telephone consultations, as well as bringing some patients into clinic for their urgent needs. Additionally, the paramedic has some developing interests in preventative healthcare, and conducts a weekly health-check and routine vaccination clinic. The paramedic also co-ordinates the learning disabilities health checks as part of these responsibilities, with close co-ordination with the GP-lead for health checks and learning disabilities.

The paramedic attends the weekly practice clinical meeting, and the daily urgent care team huddle, where roles are allocated for the day. There can be some challenges with separating ‘urgent’ and ‘routine’ care when it comes to continuity, although the weekly practice meeting is an opportunity for cases to be discussed between the team. The paramedic is encourages to seek advice from the GP that knows the patient best, rather than always the duty GP, if that is appropriate. The practice has invested significant time in ensuring the paramedic and GPs know each other through a prolonged induction and shadowing period, which – whilst logistically challenging to organise – has resulted in a good understand of roles, abilities and interests. The paramedic welcomes the ability to develop clinically, despite the very different role from the ambulance service.

The patients are aware the practice operates an Urgent Care Team model, and are used to seeing non-medical and associate clinicians with urgent same-day problems as part of this model. It is clearly explained to them by reception and on all of the practices outward-facing material. Patients are usually satisfied with the improved access, and accept the longer wait to see a GP if they prefer for more complex problems. Some patients struggle to differentiate between paramedics and ANPs, and assume they are the same profession.