Cygnet, Tasmania, Muwinina and Palawa Country

'I don't think I've ever gotten so many ‘thank yous’ in my entire career.'

After 15 years on road with New South Wales Ambulance, paramedic Ben Smith was looking for a change of professional pace. The night shifts had become increasingly taxing and the enjoyment and satisfaction he had previously derived from his work had waned.

In a bid to reignite his passion and achieve a better work/life balance, he scaled back his hours from full-time to part-time and then to casual. To no avail. “I felt paramedicine wasn't for me any more,” he said.

While working in the interim as a landscaper, he came across an advertisement for casual employment as a paramedic with the Australian Defence Force (ADF) through a private contractor to support an army training exercise in Queensland

“I'm like, ‘Oh, I've got some spare time off, I'll give that a go’. And I loved it. It was the patient contact side of things; it was clinical, but it wasn't the grind that on-road ambulance service had become for me. I came back from that contract thinking, ‘I can still do this’.”

What followed was a series of paramedic placements with the ADF, civil construction sites such as the Snowy Hydro Scheme and mining operations, and later with the National Aboriginal Health Service in Wiluna in Western Australia and the WA Community Country Health Service’s Kimberley Ambulance Service working in Indigenous communities. What became apparent after his stints in WA was his passion for working in primary healthcare and the level of patient contact and engagement that it involved.

“I really enjoyed it; this is exactly what I was after. I've got the primary healthcare side of it, I've got the in-clinic side of it, but I still get to go out and on occasion use those critical care skills.”

Following his passion, in October last year he joined Cygnet Family Practice in southern Tasmania, the sole paramedic working as part of a multidisciplinary team comprised of nurses and nurse practitioners.

“I saw the Cygnet job come up in Tasmania, and it was a lot of what I'd already done. I was confident that I could do the primary healthcare work. And it was a roster; no night shifts, three days on, four days off, so I knew I'd be able to build a community and have that balance again, a life again.”

Cygnet is the only urgent and after-hours service currently operating in the town, serving a population of 4,800. For residents, the ability to access urgent and after-hours services has spared many the 110km return trips to Hobart for emergency treatment.

In a recent incident, a woman who dislocated her finger at 7pm in the evening had no way of getting to and from Hobart. Working alongside his after-hours nurse practitioner colleague, he administered a ring block and realigned the finger. The nurse practitioner wrote a referral for an X-ray that enabled the patient to avoid an emergency department presentation. She was back home with her family an hour later, with a functioning digit and significantly less pain.

Cygnet’s urgent and after-hours service has proved enormously popular, and word of mouth has fuelled a booming practice.

“People are happy about it. I don't think I've ever gotten so many ‘thank yous’ in my entire career. The local population is genuinely appreciative and grateful that there is an urgent after-hours service. They're telling other people in the community, ‘Call Cygnet, they've got urgent and after hours; you'll be able to get in and see them’. A lot of them are pretty reluctant to make the drive to Hobart, so if I can suture someone up and our nurse practitioner can order antibiotics, they avoid that trip.”

At present, Ben works from Thursday to Saturday, from 9.30am to 9.30pm, and has a consultation room next to his nurse practitioner colleagues. During normal business hours, he sees patients who are unable to secure a booking with other GPs in the town as well as handling emergency call-outs under a memorandum of understanding with Ambulance Tasmania.

“If they can't get in to see their GP and they're not a patient of Cygnet Family Practice, they can still get in to see the urgent and after hours team. A lot of the time I can deal with it on my own. If I can't, then the nurse practitioner is practicing in another consult room.

“A couple times a week, a community call comes in, so that might be police on scene or a person who has a medical issue. It may be someone who’s called the clinic saying that they're physically not capable of coming up to the clinic or they want someone to come out and tell them if they need to go to hospital or not. I go out for that.”

It’s while on community calls that he comes across sicker patients and people with more severe injuries who require ambulance transport. While the nearest Tasmanian Ambulance station is located in Huonville about 20 minutes aways, their geographic range means it can sometimes take an hour to arrive on scene. Equipped with treatment and kit bags, his role is to assess the patient on scene, administer urgent medical assistance as required, and stabilise the patient until the ambulance arrives.

Cygnet’s multidisciplinary model of team-based care is one that is gradually being adopted in Australia in primary and urgent care health environments as a growing number of health services realise the value and utility of paramedics’ capabilities and experience in providing more responsive and holistic patient care.

For Ben, it’s a steep learning curve, but one that is continually building confidence and trust in his knowledge and skills.

“It's about my competencies, what I’m trained in and what I'm confident about. I like that the responsibility's on me. It's not predetermined - this is what you've got to do or this is what you can't exceed. It's up to me within my skills, knowledge and experience. A lot of the time I can deal with things on my own. If I can't, then I consult with my nurse practitioner colleague.

“In the primary healthcare setting, any wound care skill I learn, I get to use that almost immediately. I've got a course in Perth in April for minor surgery and skin excisions and biopsies. Whatever skills I acquire, whatever skills I become confident in, I can then go, ‘Hey, this is what I can do now’. So then another subset of patients can be seen to and treated.”

He hopes more medical practices will embrace Cygnet’s multidisciplinary approach and recognise the important role paramedics can play in delivering improved health services for communities.

“The opportunities to branch out from pre-hospital ambulance in particular are woefully limited for what we can do and for the benefits we can provide.”