Urgent and Unscheduled care [UUSC]
Dealing with urgent requests for help, triaging and treating emergencies in general practice are part of a GPSTs core curriculum (see Urgent and Unscheduled Care topic guide below)
Traditionally it was felt that Out of Hours [OOH] was the main environment where trainees could gain this experience. 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 develop capabilities in Urgent and Unscheduled Care outside of the OOH setting.
However, there are particular features of unscheduled care that require a specific educational focus, such as the increased risk of working in isolation, the 'high-stakes' nature of clinical decisions, the relative lack of supporting services and the frequent need to promote self-care. To address these, it is important that trainees spend sufficient time in both in-hours and out of hours settings.
Trainees will be expected to demonstrate their capability through reflective log entries specifically referring to the UUSC environment in the following areas:
Promoting self care
Educational Supervisors will need to play an active role in guiding Trainees through their work in Urgent and Unscheduled care, particularly in discussing with Trainees in ST3 when they would be rated as “green” and hence ready to work in the OOH arena.
The RCGP is clear that Trainees, on successful completion of training, need to be competent to work in any primary care environment.
The sessional requirements 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
It is expected that trainees use a variety of evidence to demonstrate competence in Urgent and Unscheduled care (both learning logs and WPBA). Clinical cases should be linked to the relevant Clinical experience group – Urgent and Unscheduled care
Trainees must complete the Schedule of Evidence form (see Link 6 below) Trainees clearly document the location of their evidence and attach the Schedule of Evidence form to a log entry under ‘Supporting evidence’.
In order to demonstrate capability in Urgent and Unscheduled care :
- Trainees are expected to undertake a minimum of 6 OOH Shifts in ST3.
These should be logged on the portfolio as ‘Supporting Evidence’ 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.
- Trainees must include additional Clinical log entries and WPBA demonstrating how they have achieved competence in the following areas while working in UUSC
- Patient safety
- Promoting self-care
- A final reflective piece that summarises their experience in Urgent and Unscheduled care and states that they are competent to work effectively in managing acute illness in the Primary Care environment.
Completion of the schedule of evidence with the 14 entries [ 8 OOH sessions, 5 capabilities plus summary] 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 and would 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.
- Resources available Out of hours to provide appropriate care for patients e.g. Point of access for patients with mental health problems, rapid response teams etc
- 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.
- Appropriate coding of problems to help populate the Summary Care Record
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.
In exceptional cases where trainees have been unable to access the recommended number of out of hours shifts robust evidence will be necessary to support capability in Urgent and Unscheduled care in other settings. This must be discussed with the Educational Supervisor and flagged in educator notes on the e portfolio together with an appropriate explanation on the ‘Schedule of Evidence’.
Enhanced OOH Trainees
Trainees who envisage a future portfolio career that involves working in urgent and unscheduled environments, including OOH, should have the opportunity to develop their skills further. The providers would be happy to support 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.