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.
The new guidance ( COGPED OOH position paper ) moves away from ‘counting hours’ of OOHs work completed. Instead it puts responsibility onto trainees to ensure full and comprehensive learning has been undertaken across six key OOHs competencies:
- Ability to manage common medical, surgical and psychiatric emergencies
- Understanding the organisational aspects of NHS out of hours care, nationally and at local level
- The ability to make appropriate referral to hospitals and other professionals
- The demonstration of communication and consultation skills required for out of hours care
- Individual personal time and stress management
- Maintenance of personal security, and awareness and management of security risks to others
UUC FAQs (Wessex) explains how this guidance is implemented in Wessex.
You will need sufficient evidence of engagement with and performance of Urgent and Unscheduled care for your Educational Supervisor to make a judgement of progression in this area during training and a judgement concerning competence in this area at the end of ST3. Evidence may be generated throughout your GP training, including whilst in hospital posts (for more detail, see Examples of UUC activities and Evidence).
However, during your GP training posts in ST 1&2 and ST3 you must develop and demonstrate capability in UUC work, including OOHs, outside your training 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 could provide an effective piece of evidence towards attainment of UUC capability. Observational sessions in ST2 are particularly appropriate for developing competency 2: “Understanding the organisational aspects of NHS out of hours care, nationally and at local level”, but may also develop other competencies including 5 and 6. Because you are not providing any clinical care during observational sessions you should not use them to demonstrate competencies 1, 3 or 4.
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.
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
UUC experience outside your training practice during ST3 will be done with the Out of Hours provider(s) for your area.
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.
This form records the hours you worked (to justify ‘time off in lieu’ from clinical sessions in your usual working week), the type(s) of consultation and level of supervision, learning points, any competencies demonstrated and future learning needs. It must be countersigned by your clinical supervisor for the session and reviewed by your GP trainer.
An example of a completed form is UUC session record- completed. These sessions are likely to be particularly appropriate for providing evidence towards competencies 1, 3 and 4. All UUC/OOHs clinical sessions must be supervised – the level of supervision will vary depending on your prior experience and current competence and should be agreed with your clinical supervisor for each session.
The GPST must complete a Registration Form prior to commencing any OOH sessions which is to be forwarded to both their Clinical Supervisor and OOH provider, and scanned to their ePortfolio.
Your GP trainer is ultimately responsible for deciding whether your UUC/OOHs experiences are appropriate and adequate to demonstrate UUC capability for your final ARCP and CCT. It is important that you meet regularly to discuss your progression in this area, identify your main pieces of evidence and consider where there is need for further development and the best way(s) to achieve this. Ultimately you must identify your main pieces of supportive evidence using the UUC Evidence for ARCP document which is then uploaded to your ePortolio so it is available for the ARCP panel to review if required. It may be helpful to review and update this document together regularly during the ST3 year to help guide your future UUC/OOHs work.
How do I arrange an OOH session?
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 (email@example.com)
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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.
In Dorset, the trainee will need to contact Ellenor Peaty at SW Ambulance Service who will co-ordinate your OOH sessions with the Urgent Care Service. Email or phone 01202 851332 (Monday to Thursday 8.30am – 5pm), in Ellenor’s absence contact Pat Hyde on the same number.
Booking Paid (Post CCT) Shifts Whilst Still an ST3
ST3 trainees are allowed to book OOH sessions following the rules as set out below:
- ST3 contacts Ellenor Peaty or the rota admin team requesting permission to book shifts.
- 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.
- The ST3 fills out an application form, having got all their paperwork together, including their final certificate.
- 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.
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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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