Research Protocol for a Retrospective Descriptive Analysis of Interventions Provided by Advanced Paramedic Staff Working in Primary Care in Northern Ireland

The Paramedic profession in the United Kingdom (UK) is traditionally associated with the provision of emergency care within an ambulance service. Within these services and Emergency Medical Systems (EMS) they respond to life-threatening emergencies through the 999 call system. However, since 2002, Paramedics in the United Kingdom have increasingly worked across the health system, with many choosing to work in a primary care setting. Workforce data for Northern Ireland is not available, however according to NHS England data, in May 2024, 1,076 full time equivalent (FTE) paramedics worked in General Practice in England (NHS England 2024a) which compares with April 2024 when NHS England calculate that 17,236 FTE paramedics work for an ambulance service (NHS England 2024b). Whilst these are English figures, it indicates the extent to which Paramedics are moving into non-traditional roles. Despite the role existing since 2002, and an ever-increasing shift towards paramedics working in General Practice, it has been highlighted in many previous studies (Eaton et al 2020, Eaton et al 2021, Stott et al 2024, Wagstaff and Mistry 2024) that there is a current gap in the evidence base regarding many facets of the paramedic role in general practice. The existence of a variation of employment and deployment models which include who the employer is, either a GP, Primary Care Network or Ambulance service and how the paramedic is utilized by the GP (Eaton et al 2021, Stott et al 2024, Schofield et al 2020) has been identified as one of the most significant obstacles to adequate evaluation and research of the impact and benefit of the paramedic role in primary care. Furthermore, there is also a shifting regulatory framework for all non-physicians working in primary care, with different regulators adopting contrasting approaches. The Health and Care Professions Council (HCPC), as the regulator for paramedics in the UK, have recently updated their advanced practice regulation guidance and have decided against introducing specific regulation for those working at an advanced practice level (Gledhill 2024). The HCPC (Gledhill 2024) stated “the case for additional regulation of advanced practice had not been made and that remains our position. We are working with our stakeholders to develop that common understanding of what advanced practice is while ensuring we do not stifle innovation and the development of advanced practice roles”. In conjunction with the variance of use and deployment methods for paramedics in General Practice, a key finding of the study by Stott et al 2024 was that there is no universal paramedic scope in general practice, which could lead to confusion both across different practices and within practices as to the impact a paramedic can have in general practice and their role in it. The situation for general practice in Northern Ireland is fraught, with sustained pressure on services resulting in 2023 seeing 14 surgeries hand back their GP contacts (Reid 2024). These challenges include workforce crises, staff retention and financial pressures. In addition, the Royal College of General Practitioners Northern Ireland (RCGPNI) published a GP retention strategy titled “A Workforce Fit for the Future” (RCGPNI 2024) which outlined how to maintain GP services, with an emphasis on the building of a sustainable wider multi-disciplinary team. A systematic review of the contribution of paramedics in primary care (Eaton et al. 2020) concluded that, “there is insufficient detail regarding the clinical contribution of paramedics in these clinical settings. In addition, a mixed methods scoping study (Schofield et al 2020) also found that “The contribution of paramedics in general practice has not been fully evaluated. There is a need for research that takes account of the substantial variation between service models”. Whilst Eaton et al 2022 was a survey which looked at clinical work for paramedics in general practice and they self-reported the types of conditions they consulted on and their frequency of occurrence. At the time of writing, no authors have reported on the scope of clinical work undertaken by a paramedic in general practice, demographics of the patients consulted, and potential outcomes for the patient and the practice. Thus the purpose of this study is to help to develop a greater understanding of the paramedic role in General Practice, the patient cohorts seen by an Advanced Paramedics, the outcomes associated with assessment by an Advanced Paramedic and the potential impact an advanced paramedic can have in general practice.