PERCH – Preliminary Exploration of the Role of paramedics in Care Homes

Problem

Almost half a million people live in care homes in the UK. General practices have a duty to deliver primary care for residents, but many struggle due to high demand and staff shortages. Meanwhile, ambulance services are seeing an increase in 999 calls from care homes. In addressing these challenges, one emerging approach is to involve paramedics in proactive support to care homes, part of a larger scale shift towards paramedics undertaking non-emergency primary care and community based work. Yet such major workforce changes require urgent evaluation to understand implications for care home residents and staff, and for health services. Care homes are an under-researched environment, despite high health and social care needs of residents. We aimed to explore the role of paramedics in non-emergency care in care homes to support the design and delivery of portfolio research in this emerging, and important, area.

Approach

We convened a Research Development Group of care home, ambulance service, health board, primary care, public and academic representatives, and: • Conducted fact finding visits and calls to sites where paramedics already provide non-emergency care to care home residents. • Examined data on 999 calls to the Welsh Ambulance Services Trust (WAST) from care homes.• Surveyed ENRICH (Enabling Research in Care Homes) Network care homes in Wales and the West Midlands to seek views on the potential role of paramedics working proactively in care homes.• Held a stakeholder workshop to identify and explore the issues that stakeholders deemed important in this work.

Findings

We identified multiple sites in England and Wales where paramedics provide planned and proactive rather than emergency care in care homes. Operating models varied with paramedics employed by ambulance services, health boards or general practices. Data on 999 calls from over 300 care homes in Wales confirmed call rates of up to 20 per month per home and high conveyance rates (over 60%). Our survey, with responses from 50 managers confirmed interest in the approach. Managers thought paramedic skills were well suited to assessing residents, identifying issues, improving care and avoiding admissions. They foresaw benefits to inter-professional working, clinical support and person centred care. However, they raised concerns over professional boundaries and clarity of roles and policies. These messages were reinforced in our stakeholder workshop, where the value of timely rapid assessment was highlighted, along with challenges of funding and governance.

Consequences

The role of paramedics is shifting rapidly into dedicated primary and community work, including care home settings. It is imperative that research is aligned and informs evidence based practice. We plan to take forward the findings by developing PERCH2, a feasibility study evaluating the impact of paramedics working in this way.