Training in an out of hours (OOH) setting remains anessential component of training for General Practice. By the end of vocational training GP registrars should befully competent to work unsupervised in a GP OOH setting and trainers will haveto document this on the e-portfolio.
The revised paper on this is on available on the COGPED website, click the following link:
http://www.cogped.org.uk/page.php?id=199
RCGP Curriculum and out of hours work.
The curriculum statement “Care of acutely ill people”has 6 generic competencies embedded within it:
- Ability to manage common medical, surgical and psychiatric emergencies in the OOH setting
- Understanding of the organisational aspects of NHS OOH care
- Ability to make appropriate referrals to hospitals and other professionals in the OOH setting
- Demonstration of communication skills required for OOH care
- Individual personal time and stress management
- Maintenance of personal security and awareness, and management of the security risks to others.
These are the key out of hours competencies, but clearly other areas ofthe curriculum will be covered during out of hours sessions.
Minimum time that must be undertaken in out of hoursduring training.
GP registrars are contracted to work at least 72 hoursin an OOH setting during their ST3 year. For those doing some general practicein ST2 they must complete an additional pro-rata amount of time (ie 36 hours ina 6 month attachment). Anyregistars who have an extension of training must also do a pro-rata amount oftime in out of hours during that attachment.
Attachments to other out of hours services (non GP)
We recognise that valuable learning opportunities maybe provided by attachments to other services (eg. Ambulance service, MacMillanservice, NHS direct, Mental Health Crisis teams). Such experience should normally be done during your GPST1/2attachment, and in any case should not exceed a total of 18 hours. Extendedhours surgeries should not be included as out of hours experience.
Level of Supervision during out of hours work
We recommend using the traffic light guide to clinicalsupervision. Cinical supervisors(in discussion with trainers if necessary) must be confident in the GPSTsability before moving through these levels. GPST3’s should be able to consultwith remote supervision (green) for at least 18 hours at the end of theirtraining.
Direct supervision theGPST is supervised directly by the clinical supervisor
[red] and takes noclinical responsibility.
Closesupervision theGPST consults independently but with the clinical
[amber] supervisor close athand e.g. in the same building.
Remote supervision theGPST consults independently and remotely from the
[green] clinicalsupervisor, who is available by telephone. An example of such a session wouldinclude a session ‘in the ‘car’ supervised by another GP ‘at base’.
Communication and Recording
All OOH sessions must be recorded on the e-portfolio(and “shared” with the educational supervisor). In addition, a record of each OOH session must be documented using the OOH Record Template, which should be signed by both educational and clinical supervisors and uploaded onto the e-portfolio.
Cancellation of Sessions
Late cancellation of bookedout of hours sessions is not acceptable unless there are exceptionalcircumstances. Out of hoursclinical supervisors should report all cancellations to the trainer.