The National Health Service (NHS) in the United Kingdom is facing a 5% year-on-year increase in demand for urgent and emergency care services. In 2018/19, ambulance services in England provided a face-to-face assessment to nearly 7.9 million incidents, of which 7.6 million were conveyed to hospital. This conveyance rate of around 69% is occurring despite an increase in urgent cases and is placing increasing demands on already crowded emergency departments (EDs), leading to decreased availability of ambulances as turnaround times at hospitals increase. ED overcrowding is a significant issue for patients, resulting in poorer quality of care, increased healthcare costs and potentially, increased mortality.
Yorkshire Ambulance Service have been early adopters of initiatives to address inappropriate conveyance, and have had paramedics working in the role of Emergency Care Practitioners (ECP), since 2004. ECPs consistently have non-conveyance rates double that of other paramedics in the Trust. More recently, the specialist paramedic (SP) role has been introduced, although the educational programme is less substantial than that of the ECPs, and non-conveyance rates have been no different to other paramedics within the Trust.
In 2018, Health Education England funded a pilot scheme to rotate paramedics into a range of healthcare settings, with the aim of improving patient care and relieving pressures on primary care, ambulance services and other parts of the NHS in a sustainable way. This pilot also presents an opportunity to develop SPs and potentially, improve their rates of appropriate non-conveyance which may deliver patient and cost-benefits of the role as originally anticipated.
This study aims to evaluate whether the paramedics who have rotated into primary care, are appropriately and cost-effectively increasing the level and trend of non-conveyance decisions compared to a matched control population of YAS paramedics.
This study will use a dataset comprised of non-identifiable, routinely collected, ambulance service data to undertake a controlled interrupted time series analysis. This is one of the strongest quasi-experimental designs to detect change in the level and trend of paramedic appropriate non-conveyance decisions. The cost-effectiveness analysis will examine the cost per appropriate non-conveyance achieved for patients receiving care from paramedics who have completed a 10-week rotation in a GP surgery compared with those receiving care from paramedics who did not take part in the primary care rotational pilot.
