Pilot of paramedic palliative care team is a ‘game changer’ says GP

A ‘game changing’ new service under which specialist paramedics support people in their last days of life has been praised by GPs.

The Welsh Ambulance Service Trust (WAST) appointed its first dedicated palliative care paramedics in October 2021

The specialist paramedics provide palliative care – which assists with the relief of pain, symptoms and stress for people with a life-shortening illness – and also work alongside relatives to support the care of their loved ones.

According to Swansea Bay University Health Board (SBUHB) the four-strong paramedic team underwent training at Morriston Hospital, and now work alongside Swansea Bay’s specialist palliative care team, dividing their time between patients in the community and those in hospitals and hospices.

The pilot service which commenced in December is the first of its kind in the UK. Speaking on the health board website, Swansea GP Dr Chris Jones said the service was already making a real difference.

He said: “It’s a daunting area. Even though we deal with such cases on a daily basis, it sometimes needs specialist input and liaison with a service that has more specialised knowledge and understanding.

“It is an area of the utmost importance. It is a very critical time in people’s lives, and their families. It’s not something that can be delayed. These are situations that have to be dealt with on the same day. Having the palliative care paramedics available has been game-changing.”

Steamlined

Dr Jones said that, under the previous someone from the surgery or a palliative care nurse or doctor would visit the patient at home before liaising to make a plan, but this could take time and delay support.

Under the new initiative the team can often respond on the same day, or even within the hour.

Dr Jones said: “I phone the advice line and speak to one of the palliative care clinicians. They provide advice about what needs to be done at my end. If appropriate they will contact the paramedics who will go out to the patient’s home.

“They liaise back with the observations and examination findings, and with specialist advice if it’s needed. We can arrange for any prescriptions and drugs charts to be provided to the family. It’s good for the patient, and the family.

“The paramedics can provide that extra support to the families. They link with the GPs and the consultant and act as the face of many services, rather than have a GP and a palliative care consultant, then possibly the GP again. They are bringing services together to support people.”

Dr Jones said the service also allowed continuity of care, by involving one GP, one palliative care consultant, and one paramedic.

“Previously I may have been involved to begin with but if I was not available the following day, another GP would pick it up. It has streamlined the whole process, with obvious benefits for patients.”

Flexible & responsive

The health board says that having the paramedic team in addition to the pre-existing specialist nurse cover, which is available throughout the week, along with support from on call specialist doctors makes the service more flexible and responsive.

Further benefit comes from paramedics offering improved availability at times when other services are more difficult to access, such as over the weekend or in the evenings, when very ill people and their families may have the greatest need.

Swansea Bay Palliative Medicine Consultant, Dr Idris Baker, who helped trained the specialist paramedics, said: “We’re so pleased to see how these paramedics are fitting into the team and grateful for support from the ambulance trust as well as the health board to get them up and running.

“They add a string to our bow. We have contact with lots of people at home every year across Neath Port Talbot and Swansea. Many of them we can see face-to-face, but we haven’t always been able to do that as quickly as we wanted or as they needed.

“The paramedics’ responsiveness and their skills in assessing patients and their situations are already so helpful in guiding how we support district nurses and GPs in their care. And they are so enthusiastic in how they go about it.”

Ed O’Brian, Lead for the Welsh Ambulance Service End of Life Care, said: “We’re so pleased to hear that this joint initiative between WAST and Swansea Bay has been so well received, and that’s it’s benefiting not only patients but also other health care professionals.

“When we introduced this new role, it was the first of its kind, an unproven concept, so we’re constantly measuring and evaluating to ensure it is bringing maximum benefit.

“Receiving this positive feedback from Dr Jones is really pleasing to read.”

WAST says it hopes to build on the success of the role first piloted in Swansea Bay by expanding the service to other areas of Wales.