Out of Hours

Out-of-Hours (OOH) Guidelines- The requirements for Out of Hours and Urgent Unscheduled Care changed in August 2019.

Covering out of hours (OOH) remains an important part of GP training and is a challenging part of general practice.

 

UUC and OOHs in ST 1&2 GP training posts

In ST 1 & 2 you should organise observational sessions with other community services providing urgent and emergency health and social care in your area ( GPST1/2 trainees are encouraged to gain out-of-hours experience in a variety of settings. This can include working with twilight district nursing services, paramedics, community mental health crisis teams, community palliative care teams and duty social workers. Other options include following an undertaker, police officers, prison staff or members of the RNLI crew in out-of-hours sessions. A maximum of one session (outside of usual weekday working hours, 0800 – 1830) can be spent working in a walk-in centre.

You should use the UUC observation session record form to record your attendance at such a session and describe your learning. If this record is attached to and expanded on within an ‘OOHs session’ learning log entry, then it can provide an effective piece of evidence towards attainment of capabilities in UUC.

These sessions are entirely educational (you should not provide clinical care or take any clinical responsibility for patients) and therefore contribute to the educational component of your 40 hour working week. Some could be done ‘in hours’ during your personal study session, but it is also important that several are done OOHs when there is a more limited range of services available and patients/clients are likely to be unfamiliar to the team

Sessions length for the purposes of learning should normally be 4 – 8 hours. This may not always be possible in some attachments (i.e. on an Ambulance shift) and should be clearly explained in the Learning Log Entry.

UUC & OOH options for ST1/2 trainees:

  • OOH – Ambulance Service: Please contact Tonia Meakin at SW Ambulance Service who will co-ordinate your OOH sessions with the Ambulance Service. You will need to complete and return the attached form, which can be electronically signed from and NHS account or will need to be hand signed from a personal account.
  • 111 Observational shift with the Integrated Urgent care Services:
    Please contact  Christine Bott
  • Boscombe & Springbourne Health Centre: Please contact Dr Mufeed Ni’man at Providence Surgery on 01202 395195 or 07719 676464
  • Twilight Nursing Team: Please email Clare Head or phone 07789 271903.
  • Psychiatry Crisis Team in Bournemouth: Please complete the attached form and return it to Odette Chandler when arranging your session. You will need to take along with you to the session some photo ID (passport or driving licence) and your Trust ID badge.
  • Psychiatry Crisis Team in Yeovil: contact Holly Court unit on 01935 411605.
  • Acute Paediatric Assessment Ward Poole Hospital: Contact Dr Sumit Bokhandi via his        secretary, Wendy Edwards, on 01202 442177.
  • OOH Social Services – Dorset wide: phone 01202 657279 (Mon-Thur after 5pm or Fri after 4pm).
  • Dorset Police Force – join the Police in Dorset as an observer for a day. Apply via their website here: Dorset Police Lay Observation Scheme

UUC and OOHs in ST3

One of the requirements during GP training is to demonstrate your capabilities in Urgent and Unscheduled care.  This includes delivering safe patient care, demonstrating effective communication skills, maintaining continuity for patients and colleagues, coordinating across services and enabling patient self-efficacy.

The requirements for urgent and unscheduled care, which includes out of hours have recently changed and the attached document will explain in more detail what is required in order for you to demonstrate your capabilities within this curriculum area.

The RCGP curriculum and the supporting guidance document on Urgent and Unscheduled care do not specify the number of hours needed to meet the capabilities within this setting, nor a specific number of log entries.  However, it is stated that “whilst it is recognised that knowledge and skills needed to develop Urgent and Unscheduled capabilities may be gained “in hours” and in varying secondary / community / urgent care services, there remain particular features more likely encountered in a primary care urgent care setting that require specific educational focus. Thus, to gain experience of, for example, working in isolation and with relative lack of supporting services GP trainees will need significant opportunities to develop these capabilities in primary care based Urgent and Unscheduled care / Out of Hours provider organisations.” It is envisaged that in order for a trainee to demonstrate the required UUC capabilities they will still need to spend a minimum of 48-72Hrs gaining this experience during ST3 training.

It is the responsibility of the individual trainee, in discussion with their Educational Supervisor, to ensure that they have sufficient experience across a range of settings to be able to meet the required capabilities. It is the responsibility of the Educational Supervisor to ensure that they are satisfied that these have been met before signing off the final Educational Supervisor Report (ESR).

UUC experience outside your training practice during ST3 will be done with the Out of Hours provider(s) for your area.

How do I arrange an OOH session?

Supervision during a session

The three types of consultation in UUC and OOHs work are Telephone Assessment (triage), Face to Face (clinic) and Home Visiting (car).  Gaining experience in all of these is important to develop fully your capability in UUC and OOHs. You must complete an UUC session record form for each session that you work and attach this to an OOH Session learning log entry.

After the session, pull out and reflect upon specific cases that you saw to highlight the required capabilities in the OOH setting and record them in your e-portfolio as a Clinical case review.

UUC within the training practice during ST3 eg duty doctor session.

Record cases on the UUC session record form and share with trainer. Then upload the record sheet to portfolio as evidence that the session has been undertaken.

After the session, pull out and reflect upon specific cases that you saw to highlight the required capabilities demonstrated and record them in your e-portfolio as a Clinical case review.

Update the rolling ARCP summary sheet as evidence of UUC which will be required for your annual ESR and ARCP panel review, this should be uploaded into your e-portfolio.

 

If your trainer or another GP in  your practice does OOH work, they will often be able to supervise your sessions. If not, then you will need to contact another accredited OOH supervisor to arrange supervised sessions. A list of supervisors is found in the document below. This file is password protected and the password may be obtained by emailing the Dorset GP Centre (gpcentre@bournemouth.ac.uk)

Dorset GP OOH’s Supervisors 2019-2020 (updated Nov 19)

 

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Urgent Care Service

  • UCS Introduction – explains the philosophy and context of the Urgent Care Service locally.
  • UCS Honorary Contract – this contract must be completed before work with the UCS is started.

Booking Paid (Post CCT) Shifts Whilst Still an ST3

ST3 trainees are allowed to book OOH sessions following the rules as set out below:

  1. ST3 contacts Ellenor Peaty or the rota admin team requesting permission to book shifts.
  2. They are able to do this but not under their own name, rota admin team will book the shifts under “DoctorDoctor” but making a note of the ST3 who has booked the shift.
  3. The ST3 fills out an application form, having got all their paperwork together, including their final certificate.
  4. When this is approved, they can then have the shift put into their own name as a sessional GP.

They are not paid to do any shifts whilst they are still in training.  For further information please contact Ellenor Peaty.

Our Employment Guidelines and Documents sections may also be of some use.

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Last Minute Sickness

In the event that a GP clinical supervisor goes off sick at the last minute:

  • OOHs service identifies this at the earliest stage and endeavours to contact the trainee concerned preferably before they arrive at the treatment centre
  • A senior manager/supervisor discusses the options with the trainee namely: cancel their shift and go home, go to an alternative treatment centre where there is a GP clinical supervisor, work remotely with a clinical supervisor on the telephone, spend a shadow shift with another UCS employee
  • If the trainee wishes to stay on for the shift then a GP clinical supervisor is identified
  • Reassure the trainee that we are a large multidisciplinary organisation with paramedics, emergency care practitioners, nurse practitioners and GPs who they can contact at any time to seek advice or hands or face-to-face assistance

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