Paramedic or GP consultations in primary care: prospective study comparing costs and outcomes.

Abstract

General practice faces pressures because of increased demand and a shortage of GPs. Paramedics in general practice (PGPs) increasingly contribute to managing minor illnesses, conducting home visits, and providing urgent consultations. To explore the impact of paramedic consultations on patient-reported experience, safe management, and NHS costs. Prospective cohort study comparing PGP with GP consultations at 34 GP sites in England. Eligible participants had a consultation with a PGP (25 PGP sites) or GP (nine non-PGP sites) between May 2022 and February 2023. Questionnaires were provided after the initial consultation and 30 days later. Questionnaires assessed patient experience, outcomes, and perceived safety (PCOQ and PREOS PC), quality of life (EQ-5D-5L), and healthcare use. Of 715 participants recruited, 489 completed the 30-day questionnaire. No evidence was found that PGP consultations resulted in greater improvement/deterioration in patient-reported health and wellbeing (-0.03, 95% confidence interval [CI] = -0.09 to 0.04); confidence in health provision (-0.05, 95% CI = -0.15 to 0.05); health knowledge (0.05, 95% CI = -0.04 to 0.15); or confidence in the health plan (-0.06, 95% CI = -0.11 to -0.01) over the 30-day period. However, the PGP group reported lower confidence in health provision (mean 4.0 versus 4.5; <i>P</i><0.001), poorer perceptions of practice engagement in safety promotion (median 75 versus 88; <i>P</i><0.001), and more communication problems with staff (17% versus 8%; <i>P</i><0.001) immediately after the initial consultation. Patients receiving PGP consultations reported fewer GP appointments during the 30-day period; however, savings to the NHS were offset by higher use of other healthcare professionals. Well-designed training and supervision are needed to ensure PGPs have the right knowledge and can clearly convey healthcare plans to patients. While PGPs may reduce GP workload pressure, they do not necessarily reduce NHS costs.