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They might usually be seen in ambulances or emergency departments. But paramedics say they are “invisible” professionals in Australia’s health system, who could also be employed in doctors’ surgeries and urgent care centres, if only red tape was gone and Medicare recognised them.
As submissions open in a government review investigating how various health practitioners can do more to relieve the strain on the health system, paramedicine has become the fastest-growing health profession in the country.
Crown Resorts manager of clinical governance and medical response David McLeod (right) and paramedic Vandan Tevani in Crown Sydney’s health centre. Credit: Kate Geraghty
Ryan Lovett, chair of the Australasian College of Paramedicine, said he wanted to see paramedics employed in primary care settings – particularly as some patients turn to emergency departments instead of their GP to avoid rising out-of-pocket fees.
“Urgent care is paramedics’ bread and butter,” he said. “But there’s no option for general practices to employ them. They can’t pay a practice paramedic under Medicare like they can for nurses.
“We’ve seen a small number of GP clinics and urgent care centres have made those decisions to employ paramedics themselves – bearing the cost – because they recognise the benefit.”
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David McLeod works in one such clinic. He leads a team of paramedics that staffs 24/7 urgent care centres at Crown resorts for travellers, residents and employees in Sydney, Melbourne and Perth.
“The new era of primary health paramedicine is one that doesn’t really focus a paramedic in an ambulance vehicle. It has a focus on chronic conditions, long-term health goals, and looking after the whole wellbeing of a patient,” McLeod said.
His team assesses workplace injuries on site before linking employees with the right external health service, and monitors them afterwards to prevent further injury. It also helps staff look after chronic health issues – such as hypertension, high blood pressure or newly diagnosed diabetes – and navigate mental health services or counselling support.
“Ten to 15 years ago, that used to happen at the GP, but GPs are under pressure these days and can have minimal time with patients,” McLeod said.
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“[We’re] not just about treating someone, sending them an ambulance and sending them away. It’s about utilising paramedics’ capability to take the impact off the greater health system.”
Lovett said paramedics were generalists trained to make rapid assessments of patients – whether it be an emergency childbirth, acute mental health crisis, cardiac chest pain or stroke – and either treat and discharge them, refer them to another practitioner in the health system, or take them to an emergency department.
He said paramedics could play that role in general practices, the government’s new urgent care clinics, or in rural and regional areas where there were worker shortages. However, there was no funding option to employ them under Medicare, and there were other red tape issues around medicines and referrals.
“A paramedic might see somebody with a sporting injury, or a kid that’s fallen off play equipment and broken a leg. But there’s no way they can independently request something as simple as an X-ray or a blood test to inform the patient’s next stage of care. It has to go through a GP or a hospital,” he said.
“It’s such a lost opportunity, and it’s not providing the best care for the patient at that time. If you don’t need to take someone to a hospital, you shouldn’t take someone to hospital.”
The number of paramedics registered to work in Australia has grown by almost 40 per cent since 2019, compared to 18 per cent for the overall health workforce. There are now 24,164 registered to work in Australia, which Lovett said was more than the number of state-based ambulance jobs.
“We graduate more paramedics every year than there are jobs in ambulance services. There are paramedics out there that we can employ today,” Lovett said.
Health Minister Mark Butler said the health workforce had been held back too long, as he welcomed submissions to the government review of worker capabilities.
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Peter Breadon, the Grattan Institute’s health policy director, said paramedics had capabilities in prevention, patient education and teaching self-management of chronic disease, and would be pushing for a greater role in the government review.
“They’re one of the few workforce groups that certainly doesn’t have supply problems,” he said.
McLeod’s clinics look similar to GP clinics, fitted out with a desk, patient bed and treatment chairs. There’s also the equipment you’d expect to see: ophthalmoscopes and stethoscopes, monitors for electrocardiogram (ECG) and blood pressure tests, and a range of medications.
But he said it wasn’t their role to replace GPs, who remained the central access point for his patients outside the work environment. “It’s never about taking over the care of another professional... The GP is always the team leader. It’s all about a multidisciplinary approach,” he said.