Understanding paramedic work in general practice in the UK: A rapid realist synthesis

Hannah Stott, Trudy Goodenough, Justin Jagosh, Andy Gibson, Nicky Harris, Cathy Liddiard, Alyesha Proctor, Behnaz Schofield, Nicola Walsh, Matthew J Booker, Sarah Voss*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Background
General practice in the UK is under substantial pressure and practices are increasingly including paramedics as part of their workforce. Little is known about how different models of paramedic working may affect successful implementation of the role, as viewed from patient, clinician and system perspectives. This realist synthesis developed theories about ‘models of paramedic working in general practice’ in different UK contexts to understand their impact.

Methods
The rapid realist synthesis comprised data from: (1) empirical and grey literature searches; (2) semi-structured realist interviews with system leaders involved with the implementation of the role; and (3) a stakeholder event with healthcare professionals and the public, to develop initial programme theories that can be tested in future work. Sources were analysed using a realist approach that explored the data for novel or causal insights to generate initial programme theories.

Results
Empirical sources (n = 32), grey sources (n = 95), transcripts from system leader interviews (n = 7) and audio summaries from the stakeholder event (n = 22 participants) were synthesised into a single narrative document. The findings confirmed the presence of a wide variety of models of paramedic working in UK general practice. The perceived success of models was influenced by the extent to which the paramedic service was mature and embedded in practice, and according to four theory areas: (1) Primary care staff understanding and acceptance of the paramedic role; (2) Paramedic induction process, including access to training, supervision and development opportunities; (3) Patient understanding and acceptance of the role; (4) Variations in paramedic employment models.

Conclusions
Variability in how the paramedic role is operating and embedding into general practice across the UK affects the success of the role. These findings provide a theoretical foundation for future research to investigate various ‘models of paramedic working’ in different contexts.
Original languageEnglish
Article number32
JournalBMC Primary Care
Volume25
Issue number1
DOIs
Publication statusPublished - 23 Jan 2024

Bibliographical note

Funding Information:
We are grateful to: Our public partners for their involvement in the project oversight groups, stakeholder event, and their support in framing and interpreting the empirical literature. Pauline Shaw for her assistance with the literature searches. Alison Diaper who provided project support on behalf of the host: NHS Bristol, North Somerset and South Gloucestershire Integrated Care Board The wider “READY Paramedics” study team: Helen Baxter, Jonathan Benger, Dave Coates, Kim Kirby, Sarah Purdy, Hazel Taylor, William Hollingworth

Funding Information:
This project was funded by the National Institute for Health Research (NIHR) Health Service and Research Delivery Programme (NIHR132736). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Publisher Copyright:
© 2024, The Author(s).

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