Out of Hours Training
Dealing with urgent requests for help, triaging and treating emergencies in general practice are part of a GPSTs core curriculum (Curriculum Statement 3.03 – Care of the Acutely Unwell Patient).
Traditionally it was felt that OOH was the main environment where trainees could gain these competencies. However, it has been recognised that there is an increasing separation in many practices between Urgent and Unscheduled care and routine work, with practices adopting triage / duty / same day appointment systems. Trainees have an increasing opportunity to gain skills and competences in Urgent and Unscheduled Care outside of the OOH setting.
The Acute Care Curriculum Statement (see Link 5 below) has defined a number of skills that Trainees need to develop. Description of the skills and ensuing generic competencies that GPSTs need to demonstrate are detailed in the Care of the Acutely Unwell Patient Curriculum Statement. These have also been summarised below.
Educational Supervisors will need to play an active role in guiding Trainees through their work in caring for acutely unwell patients, particularly in discussing with Trainees in ST3 when they would be rated as “green” and hence ready to work in the OOH arena.
The college is clear that Trainees, on successful completion of training, need to be competent to work in any primary care environment.
From Autumn 2018, the changes have been made mindful of potential workforce implications for the OOH Providers. Both Devon Doctors and Cornwall 111 have been involved in the discussions and formally acknowledge their continuing support for our Trainees.
Obligations for Trainees
Trainees completing training after 01/08/2018 should document the required skills and competences in the OOH section of their Portfolio. This will allow easy identification of the skills and competencies achieved. The Schedule of Evidence form (see Link 6 below) should allow Trainees to clearly document the location of their evidence.
- Trainees should undertake a minimum of 6 OOH Shifts in ST3. These should be logged on the portfolio as previously, i.e. uploading the OOH form and making an entry about the shift. They should do these shifts only when their Educational Supervisor (ES) rates them as green.
- 6 Reflective log entries on the competences referencing the skills demonstrated.
- A final reflective piece that summarises their experience and states that they are competent to work effectively in managing acute illness in the Primary Care environment.
Theses 13 entries would usually provide the Educational Supervisor with adequate evidence to make a statement on Educators Notes that a Trainee has demonstrated the skills necessary to care for patients who are acutely unwell in a safe and sustainable way and would, if they wished, be able to work competently in urgent and unscheduled care environments.
ST1 / ST2 Trainees
Trainees will be expected to do 2 OOH sessions in ST1/2. These will be in an observational, or directly supervised, capacity (Red shifts). As well as looking at urgent and unscheduled work in GP itself, trainees should also consider this across the wider OOH environment including:
- Structures in-hours that support clinicians in the OOH setting, when there are limited resources available.
- Anticipatory prescribing protocols and ‘Just in case bags’
- Special messages, the End of Life register and communication regarding TEPs to the OOH services where appropriate.
A Trainee’s contractual arrangements will not be compromised with the new contract.
Trainees on extensions of training should do enough urgent and unscheduled care to maintain their competence in this area, but this will not necessarily involve more OOH work.
Enhanced OOH Trainees
There will be some Trainees who envisage a future portfolio career that involves working in urgent and unscheduled environments, including OOH. The providers would be happy to support some of these Trainees to do more OOH shifts, instead of some of their ‘in hours’ sessions (so as to keep within the 40 hour week). Applications from Trainees to do more OOH shifts, will need to be supported by both their ES and one of the local Patch Educators.
1. OOH Session Record Sheet (printable version)
Completed OOH Session forms should be uploaded to your ePortfolio Learning Log.