ECP Di Rankin (left) and Nurse Prescriber Janelle Weren

Tuakau, Aotearoa New Zealand

"It's actually exceeded all of our expectations"

A chronic shortage of general practitioners in rural areas of Aotearoa New Zealand was the catalyst for Tuakau Health Centre on the North Island to employ its first paramedic.

“We've been short of GPs for over a year,” said Practice Manager Majella Blackwood. “ProCare [their primary healthcare organisation] started this initiative last year. They were asking us what we would like as far as helping our clinic. We chose paramedics thinking that they would be able to see patients and ease the load for the GPs.

“At the start we really had no clue how we were going to do it, what was going to happen, what it would mean, and how we could fit them into the clinic and change the way we were already working. But it's actually exceeded all of our expectations.”

In April, Extended Care Paramedic Di Rankin, who spent 24 years with Hato Hone St John, joined the practice’s multidisciplinary team alongside GPs, a nurse practitioner, nurse prescribers, nurses, a health improvement practitioner, a health coach and a healthcare assistant, serving a community of ~6,000 people.

Her main focus is working with Nurse Prescriber Janelle Weren at the walk-in kids’ clinic, which operates two mornings a week. The initiative that was launched in May for children aged 14 and under.

“Janelle and I sat down and figured out how we could best utilise Di. Janelle can prescribe - she has a limited scope but usually with kids under 14 she's got a relatively wide prescribing portfolio. Prior to Di starting, a lot of those acute appointments were being filled up with under-14s with coughs, colds, skin infections, sore throats, those sort of things,” Majella said.

“We were trying to get kids out of those on-the-day appointments so they could be freed up for over-14s and adults. The walk-in clinic has been welcomed by the community and our patients, and we're looking to hopefully increase it to three mornings a week next year.”

Di’s day-to-day schedule generally involves telephone triage from 8am-9am in the morning and working in the kids’ clinic from 9am to midday on the two days a week that it’s open, booking appointments and undertaking procedures such as throat swabs.

“If it's not a kids’ clinic day and it's someone ringing up who's under-14, she'll book them and they’ll come in and see her, rather than use up a GP appointment.”

On other days, she works with nurses in the treatment room seeing walk-in patients, and occasionally with the acute doctor, as well as helping with paperwork and administrative matters and patient outreach in encouraging people to come in for free health checks.

Di said the biggest challenge initially was the adjustment from working as an autonomous clinician to working as part of a team and determining what her new role would entail.

“We were working alongside each other, so I guess it was a matter of them learning to trust me and me learning to trust them, and me learning how to be more of a nurse than a paramedic because the role was so different,” Di said.

“If we have an emergency come through the doors. We've pretty much got to the point that if it's like anaphylaxis or somebody really sick, I'll set up floors, put out medication, and then talk to the doctors about it. I’ve gained the trust of the doctors, which is really good.”

Di said she was also learning from the practice’s nurses, including immunisation and wound care, and is working to a set of ECP clinical practice guidelines developed in consultation with Majella and Janelle and the lead GP.

“In our system, we've in a way qualified the CPGs of some of the other clinics that are involved as well. We're cropping ideas around the things that work. We worked out what medications we use the most. So any medication I use or I've administered for a patient gets signed off by our lead GP. From the ambulance settings to what I'm doing now, I'm doing a lot more professionally.”

Janelle said the presence of a paramedic was also beneficial for the nursing staff, particularly in case of emergency presentations.

“I think having a paramedic on site, if someone comes in with chest pain or goes into cardiac arrest, you actually feel a bit safer. Obviously, we all know what to do and we have doctors who know what to do, but this is her bread and butter, so she's a lot calmer.”

The local community has welcomed the initiative, the continuity of care it provides, and the cost benefits involved, which has been accompanied by a higher level of patient satisfaction.

“Before we started for kids’ clinic, the other alternative if we couldn’t fit people in, including children, was that they went to urgent care in the nearest town, and they had to pay, any age, $60. We knew that was really hitting our patients hard,” Janelle said. “They couldn't afford it, so I think they’re appreciating the fact that it's here.

“Paramedics are really trusted in the community. When they hear that they're going to see Di, our paramedic, people are like, oh great, really happy about that. They bring a new element to primary care, which I think is good.”