Paramedics in GP surgeries may ease workload but not NHS costs, study finds

Paramedics working in primary care may help reduce GP workload but do not lead to cost savings for the NHS, a study has concluded.

A two-year evaluation of 34 GP practices across England found that although paramedics could reduce GP workload, any savings to the NHS were offset by patients’ higher use of other healthcare professionals in the 30 days after the initial consultation.

The study which looked at the care for more than 700 patients also found no differences, for better or worse, between paramedic and GP consultations in patient-reported experiences and outcomes after 30 days including health and wellbeing, health knowledge, and patient confidence in their health plan.  

But the analysis found that patients seen by paramedics reported lower confidence in health provision, poorer perceptions of practice engagement in safety promotion and more communication problems with staff immediately after the initial consultation.

This finding is worth investigating further to understand whether this reflects the care provided during the initial paramedic consultation or broader issues in primary care, they concluded in the British Journal of General Practice.

Better evidence is also needed on the impact of paramedics in general practice on appointment accessibility, consultation times, and requirements for GPs to train and supervise new staff, they added. 

Researchers at the University of Bristol and University of the West of England looked at a range of practices across urban, rural, deprived, and affluent areas and included nine practices where no paramedics were working.

They recommended that well designed training and supervision is needed to ensure paramedics working in general practice have the right knowledge but also can explain healthcare plans to patients.

There has been a three-fold rise in the number of paramedics working in GP services over the past five years to help practices meet patient demand.

Previous studies have found a wide variation in the education and clinical experience of paramedics working in primary care, and in the clinical work they do.

Study author, Dr Matthew Booker, a GP and consultant senior lecturer in primary care at the University of Bristol said: ‘Paramedics are increasingly working alongside other members of the general practice team, managing minor illnesses, conducting home visits and providing urgent consultations among other roles.

‘While our study suggests that paramedics can play an important role in general practice, easing GP workload and providing clinically effective care to patients, we have found no evidence that their use is cost saving for the NHS.’

Professor Sarah Voss, professor of emergency care at the University of the West of England, added: ‘Our study is an important first step in understanding the impact of paramedic consultations on patient experience, safety and costs.

‘Further research is needed to see whether our findings can be replicated in other primary care settings and to plan how paramedics are deployed, trained and supervised so they can quickly gain the trust of patients that they see.’

Practices have been advised to carefully consider employment law if they are planning redundancies of other employees in order to hire more GPs through the additional roles reimbursement scheme (ARRS).

The Government’s contract deal for 2025/26, agreed in principle with the BMA, will remove the ringfence around funding for ARRS GPs, meaning PCNs can use the full funding pot to hire roles as they see fit. 

This will likely result in a ‘shift’ in the skill mix, according to NHS England, with PCNs preferring to recruit more GPs via the scheme.