Looking After You Too Case Study: Paramedic Practitioner – New Role

Role and Context

The Paramedic Practitioner has been working in a GP practice in London since Spring 2020. They had previously worked in an urgent care centre and, prior to that, spent six years working with the London Ambulance Service.

They are the first Paramedic Practitioner at their surgery. The role comprises of seeing and treating patients within the practice and assessing patients at home. Increasing the availability of home visits is helping the surgery to reduce health inequalities for their housebound patients. The Paramedic Practitioner is an autonomous practitioner who is an independent prescriber.  The role aims to minimise the disruption of home visits to GP surgery schedules and reduce the number of A&E attendances.

A week before they were due to start this role, the Practitioner contracted Covid-19 and had to self-isolate. The first lockdown was in full swing when they began their role.

Challenge of Covid-19 on own wellbeing

The Paramedic Practitioner’s role changed because of the implications of lockdown, and now included telephone triage and managing patients remotely, which they said, “has been quite a challenge”.  They discussed that, due to Covid-19 lockdown regulations, numerous housebound patients had not seen anyone for many months. As a result, as well as managing health concerns, consultations encompassed the struggles of patients’ loneliness and isolation.

The Practitioner found that they were worrying more about their patients than in previous roles. When they worked for the ambulance service and urgent care, they would spend a relatively short time with each patient and would be unlikely to encounter them again. If immediate or emergency care was not required, the advice of “follow up with your GP’ was given, however they had little exposure to the remit of general practice. As a Paramedic Practitioner they realised the breadth and opportunity to assist patients with a multitude of investigations, referrals and having the ability to follow their progress and journey. They became the person patients followed up with. As each management plan, investigation and referral was novel, feelings of uncertainty rose. Moving from roles where they felt confident increased the awkwardness of asking for help. The Practitioner did not want to disturb colleagues and felt imposter syndrome, thinking that they should know the answer. Consequently, they found themselves working longer hours and felt like they were failing in their new role.

As they were the first Paramedic Practitioner at the surgery, and it was a new role nationally, there were no direct comparisons regarding performance and knowledge. Rather than raising concerns with their new colleagues, they started to ‘internalise’ concerns and had little time to decompress.

How Looking After You Too coaching helped

The Practitioner saw the email mentioning the Looking After You Too coaching service from one of the training hubs. They commented that NHS staff “generally don’t ask for help” and it was nice to see something offered to help with personal wellbeing.

They discussed how the coach listened to their concerns about stress and workload and provided impartial advice on how to manage their wellbeing. The coach suggested that they should think of stress as an elastic band that can be stretched only so far and approach their work similarly.  The coach helped them recognise the personal skills that they brought to their role, and that they should feel confident and proud of these attributes.

Through discussions with their coach, the Practitioner saw that the issues discussed were not personal but operational. They realised that they did not have to internalise their worries, and, with the support of their coach, they were enabled to articulate issues clearly and constructively with work colleagues. As a result, the Practitioner was able to work together with colleagues to better manage their workload, by transferring patients who were more suited to specific types of care. The duty doctor role was also modified to include paramedic support. This took a lot of pressure off, and they felt a lot more comfortable within the role.

Impact of the coaching

The impact on the Practitioner’s wellbeing has been positive and their anxiety regarding competency in their role has significantly reduced. They described the coaching sessions as like “a path [to better wellbeing]” and felt it was reassuring to know that they have further coaching sessions remaining. They noted that it feels like they have made positive progress and know that there will always be something new that the coach can help them with. They described coaching as “very, very useful and important” and have been encouraging others to try it for themselves.