READY Paramedics: A Realist Evaluation of Paramedics Working in General Practice: An assessment of clinical and cost effectiveness


National Institute for Health (NIHR) Health Service & Delivery Research (HS&DR) Ref. NIHR132736

What is the research question?

What different models of Paramedics in GP practices are in operation in England, and what are their impact on clinical and patient outcomes, workload, and value for money?

What is the problem?

General Practice (GP) Services in the UK are under severe pressure and, if demand continues, it is likely there will not be enough GPs to ensure that patients are always seen in a timely way. It is possible that having other practitioners working alongside GPs could reduce the pressure; some GPs are already using paramedics to carry out home visits or see patients with urgent needs.

However, these arrangements have largely arisen on a local level and without evidence to support them. We don’t know the best way to use paramedics in GP Services, if it changes outcomes for patients or if patients are happy be seen in this way.

What is the aim of the research?

Different practices have different problems to solve; one way of using paramedics may work well for one practice but not another. We will look at the effect this variation has on factors such as patient care, safety and experience, staff workload and costs to the NHS.

How will this be achieved?

We will research the different ways that paramedics are already working in GP Services in England and what works best in different situations. In phase one, we will investigate the different ways in which paramedics are working with GPs. To do this, we will search the published literature and find other publicly available documents, such as policy documents and job descriptions. In addition, we will carry out a survey of key organisations in the South West, such as GP surgeries; out of hours care providers; Urgent Care Networks and the ambulance service to ask about their experiences of paramedics in primary care and their future plans. In phase two, we will identify places that have interesting models in place and carry out in-depth interviews to understand how they were intended to work and how they actually work in practice. In phase three, we will find out if it is possible to collect relevant data from GP services that will allow us to compare different models of service. At the end of this project, we hope to have a clear picture about the different ways in which paramedics are working in GP services and what works best for patients. We will produce a number of theories about how different models are meant to work in different situations and what they are hoping to achieve. This will lead on a research proposal to carry out a ‘realist evaluation’. This would allow us to test the theories with case study sites and obtain data on the effectiveness and costs of different models.

Who is leading the research?

Dr Sarah Voss, Associate Professor in Emergency Care, Health and Applied Sciences, University of the West of England.

Further information:

Ready Paramedics

For more information or to get involved in this project, please contact

The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.