WA’s first paramedic private practice model

Multidisciplinary care benefits patients, staff and the health system 

By Rob Garner, Publications and Content Manager, Australasian College of Paramedicine 

Source: APNA Primary Times Winter 2023 (Volume 23 Issue 1)

It was a tongue-in-cheek question that led paramedic Alecka Miles to begin working alongside doctors and nurses at Dianella Family Medical Centre in Perth, Western Australia/Whadjuk Nyoongar Country. Dianella is the only private health clinic in the state to employ a paramedic in such a capacity.  

Following paramedic registration in Australia in 2018, the Dean of the School of Paramedicine at Edith Cowan University, where Alecka works as a community paramedicine postgraduate course coordinator, was jokingly asked if paramedics would now be able to work in GP clinics, such as they were in the UK. 

The Dean, who is a GP and has worked with paramedics for more than a decade and understands their unique skill sets, replied, ‘That's a really good question. Let me speak to the practice manager at Dianella.’ A year later, Alecka was spending one day a week in clinical practice at the clinic. 

‘I was doing a benchmarking project with my postgraduate course at the time and looking at how paramedics were working in different areas,’ Alecka said. ‘I wanted to go into a GP practice and see how we could fit. So as part of that benchmarking, we organized a meeting with Dianella Practice Manager Julie Stojcevski, and she agreed to let me come in for a couple of weeks and work alongside the nurses and GPs and see what value we could add and what sort of things they do, and how paramedics might fit. At the end of that meeting, I was offered a job. 

‘It’s the most amazing team, with so many forward-thinking practitioners, and it’s a very multidisciplinary team. We've got GPs, practice nurses, a diabetes educator, a podiatrist and a physiotherapist, as well as a pharmacist next door. It’s a phenomenal environment to work in.’ 

Julie said it was a case of ‘thinking outside of the box’. The clinic was looking at the ways in which quality improvements could be made, and how paramedics could be incorporated in the practice to provide support, particularly within the sphere of urgent care. 

‘We came up with this model, which we thought would be very beneficial because the paramedic would be able to work closely with the doctors, and at the same time we would also have quality improvement in urgent care to take the pressure off the hospitals. And it's a wonderful model, and we’re able to demonstrate the different roles that paramedics are playing, and how this is benefiting the health system and health care delivery.’ 

It was a seamless integration, with the different practitioners aware of each other’s strengths and the complementary nature of the different strands of professional practice. And for Alecka, staff are always available to guide her if she needs assistance or has questions relating to areas in which she is unfamiliar.  

‘We know each other's strengths and weaknesses. There's no judgement if there's something that you're not feeling confident about. Everybody is comfortable in their area of expertise; everybody is comfortable that there is an overlap in some of our skills and expertise. And egos are parked. We will often work as a team to ask questions and get a history,’ Alecka said. 

When she first joined Dianella, her work was predominantly focused on preventative health-care home visits for the over-75 population, listening to their histories, assessing the safety of their home environments, and making recommendations for support services if needed, such as fall safety education and nutritional guidance, that are then fed back to the GPs. She later began to work in the clinic on patient health-care planning and talking with patients about issues such as weight loss and the prevention of cardiovascular disease. 

Recognising that her skills were also well suited for the treatment room, Julie expanded her role to cover hands-on patient treatment, including administering vaccinations, wound care and closures and suturing, and assisting with other skin procedures, such as biopsies.  

‘We've got GPs, practice nurses, a diabetes educator, a podiatrist and a physiotherapist, as well as a pharmacist next door. It’s a phenomenal environment to work in.’  

• Paramedic Alecka Miles 

‘That's been a new skill and it's frightening but also exciting. I feel like a student again, but I'm very lucky to have a great mentor who's a skin specialist and he's been wonderfully patient. I’m so grateful for what I'm learning from him.’  

Triage is also another important component of Alecka’s work, with most walk-ins presenting after falls that result in wounds or fractures, as well as chest pains and myocardial infarctions. Julie said she was a multi-talented clinician who also did CPR training at the clinic and emergency trolley training with staff.  

‘She's an all-rounder in the treatment room. Emergencies are usually thrown her way because she's the most capable of doing that. She's established an excellent rapport with a lot of our patients, a lot of whom come in and say, “I'm just here to see Alecka, she's going to do my wound,” so she's very actively involved in our practice.  

‘The best part of having a paramedic here is her urgent care skills. Our patients call up, and if Alecka's in here she'll get on the phone and make an initial assessment, and if she feels there is a need, she’ll say, “Okay, I need you to come in straight away.” By the time the patient has come in, she's already liaised with the doctor, and we've got a plan in place. That whole emergency response for our patients – we never had that, so having that here now has definitely increased the flow of emergencies coming into our practice and eased the pressure on ambulances and the health system. 

‘It's the best thing that's happened to us. The skill set, the experience, and the knowledge that the practice as a whole has gained from having Alecka as a paramedic has been amazing. And moving forward, I would always ensure that we had a paramedic as part of our team.’