Medium Integration, Low Complexity

A medium sized, rural practice operates out of a main surgery providing full services, and a satellite surgery that has a GP three times a week. The practice serves a demographic with limited deprivation, that is predominantly working age adults with their own transport. The practice catchment area is wide geographically with considerable distances covered when undertaking home visits, which the practice tries to limit where possible.

The practice directly employs a paramedic for 4 days a week, who works at both practice sites. The paramedic undertakes a same-day minor illness clinic at the satellite site on the days without a GP, alongside an Advanced Nurse Practitioner who runs chronic disease clinics and provides on-site supervision. The paramedic conducts home visits on the other two days out of the main surgery site, following triage by the duty GP. There is protected time to debrief visits each day. For minor illness clinics, the paramedic has a list of inclusions and exclusions, and does not see children under 5, pregnant women, end of life care or mental health presentations. Minor illness lists are booked directly by reception, according to a list of agreed clinical issues (which include UTI, sore throat, cough etc). There are a number of acute care protocols which the paramedic works to, having been involved in developing these according to their competencies. On occasion, patients are referred from the satellite site to the main surgery site after assessment if they require GP input.

The paramedic wishes to continue to develop their clinical competencies and currently attends a 1-day-a-week masters in advanced practice programme at the local Higher Education Institution, which is part-funded by the practice. It has taken some time to transition from a ‘road’ paramedic to seeing minor illness in clinic, but the continuity of building relationships with a stable GP team has helped work out which patients can be confidently seen independently. Access to daily supervision is valued.

Patients value the improved access for same-day care at the satellite site, which is geographically more convenient for many who would otherwise need to travel some distance. Sometimes patients may resent the duplication if they then need to be referred to the main site to see a GP, but this doesn’t happen that often. Patients feel comfortable that they can still book to see a GP if they wish, particularly when they have a more complex health problem that they would like to discuss with a doctor.