Dear Trainees and Trainers

 

At Deanery level it has been decided that GP trainees in GP posts should have experience of both face to face care and telephone triage. Trainees will do:

sessions with NHS Direct at their Wakefield centre - which will include comprehensive training in telephone triage as well as an introduction to their systems. Training in telephone triage and NHSD's systems will be a useful addition to GP training.

1. It seems this is 'a given', although the finer detail has not yet been sorted out.
2. sessions with LCD, at Eccleshill until further notice (maybe 6) per 6m FTE in GP.

 

We've noticed that a lot of trainees are being referred to ARCP panels for making unsatisfactory progress with respect to OOH training - either not doing the minimum required number of sessions or (more commonly) not writing them up in a way that shows their reflection and learning.

 

 

It is the trainee's job to make the job of your educational supervisor and the ARCP panel easy In this case it means do the OOHs, write it up, preferably with something about what you have learnt and ideal document competencies in relation to the attached COGPED statement. Use the OOH workbooklet above in the 'downloads' section to help you.

 

 

 

Some Basics

 

Who to contact

The training programme director with lead responsibility for OOH is Nick Price. Please contact him if you have any further queries.

 

What are the guidelines on Out of Hours (OOH) commitment?

Basically you need to do on call. In hospital posts, this will be whatever the department has organised. In general practice posts, you will participate in a rota for on call with the out of hours service providers. The rota will have already been worked out in advanced and is available on this website (go to the bottom section of the home page).

 

We realise that GP trainees are human and like most doctors are not overcome with a love of on-call. You are paid a significant uplift in your salary for on-call and so cannot opt out. However, you might find it helpful to remember that the Yorkshire-Humber approach is an educational one rather than a punitive or service approach.

 

Yorkshire being so diverse in geography has different problems about on-call in different areas. There are a number of organisations involved in the delivery of OOH and unscheduled care services, including GP co-operatives, commercial services, NHS Direct, NHS 24, nurse triage, urgent care centres, minor injury centres, primary care walk-in centres (eg Darzi centres), GPs embedded within A&E departments and some remaining individual practices and practitioners. The model of service provided is of necessity varied; this also means that one model as an answer does not fit all.

 

Out of Hours expectations

The number and frequency of out of hours sessions to be completed whilst working in a training practice is defined in Form B for each post. This is usually, but not always, at least one session of at least 4 hours per month.

• Read our full Bradford OOH Policy here.

 

As a trainee you need to discuss with your trainer - and / or educational supervisor how you are going to fulfil your out of hours commitments during your induction to the training practice. Leaving this until later might reduce your opportunities to complete a sufficient number of sessions toward the end of your post and create problems when an ARCP panel assesses your portfolio.

 

There needs to be an appropriate balance between telephone consultations and face to face consultations in your out of hours experience. You should discuss this with your trainer at induction and review your progress through the post. Consulting on the telephone is an important skill and should not be neglected. As a guide it might be considered that between a third and a half of your out of hours sessions should focus on telephone consulting. This might vary depending on how much telephone consulting is experienced in the practice in normal hours and the rate of competency progression.

 

A separate but related issue is the development of the competencies detailed in chapter 7 of the GP curriculum - Care of Acutely Ill People. These competencies can be developed in a number of settings in primary and secondary care and within working hours as well as out of hours. Working in an out of hours setting provides a different and important experience in managing acutely ill people. When your portfolio is assessed by an ARCP panel evidence of satisfactory competence progression in a variety of settings will be required.

 

Finally you should remember that some out of hours centres and some sessions tend to be busier than others. It may be the case that in order to demonstrate all the required competencies you might need to do more sessions than those specified in form B or more daytime "on call" activity. You should discuss this with your trainer and educational supervisor sooner rather than later and not leave it until an ARCP panel advises that your portfolio does not demonstrate sufficient coverage of the curriculum in this area.

 

 

Specific Points for those on the Bradford Scheme

To work in Out of Hours in General Practice, you need to have a smart card to give you authorisation to access electronic medical records through a piece of software called SystmOne (why they can't spell System, I will never know!).

 

*     It is your responsibility to ensure you have a smartcard

*     Access to SystmOne OOH is only available via a smartcard and is a requirment when working OOH sessions

*     You will need to contact Susan Webster susan.webster@bradford.nhs.uk or Julie Hayley julie.hayley@lcdwestyorks.nhs.uk with your name and smartcard number so one of them (sponsor) can arrange for you to be given access to this particular unit.

*    YOU MUST DO THIS IN GOOD TIME before you are due to work OOH. 

 

A smartcard can take approximately 2 weeks to set up.  You have to provide a sponsor with the completed form and ID so they can then complete part 3.  You then need to go to the PCT to have your card issued. Adding access to this unit will normally take 1 week.  The sponsor fills out a form and sends it to the PCT for processing.

 

• Please read this document which details other common issues with smart cards.
• Read our full Bradford OOH Policy here.

 

What am I meant to be demonstrating as a result of engaging in OOHs?

The problem with OOH sessions is that they can appear very unstructured in terms of learning because of its nature (people presenting at random, unpredicatably of what will come in etc). Some trainees feel they dont get much out of OOH sessions whilst others say the opposite. The reality is that trainees who get a lot out of it either have a really good clinical supervisor OR the trainee is so motivated that (s)he maximises the learning potential within the session.

 

The main thing is that the Trainees get a wide experience in OOH which includes differing timing of shifts and telephone/visits etc.  For example, if the Trainee was in the Outer Hebrides then they might need to do more hours but in inner city areas the Trainer/Deanery might feel they have achieved the competencies required in a shorter amount of time. 

 

And these are the 6 generic competencies which YOU NEED TO DEMONSTRATE:

 

1.    Ability to manage common medical, surgical and psychiatric emergencies in the out-of-hours setting.

2.    Understanding of the organisational aspects of NHS out of hours care.

3.    Ability to make appropriate referrals to hospitals and other professionals in the out-of-hours setting.

4.    Demonstration of communication skills required for out-of-hours care.

5.    Individual personal time and stress management.

6.    Maintenance of personal security and awareness and management of the security risks to others.

 

* Encourage the OOH clinical supervisor to complete a session feedback sheet (they're meant to do this anyway) in relation to the 6 competencies above. Make sure you sshare with your trainer not only for evidence purposes but to encourage reflection and consolidate learning. Do this at the next available opportunity with your trainer.

 

 

What to write in your e-portfolio

We suggest the OOH log entry should contain:

- Basic information like the date, time, type, place, duration of session and name of Clinical Supervisor e.g Wednesday 14th April,  19:00- 23:00, base doctor, Airedale GP OOH centre,  4 hour session.

- In depth reflection on some or most of the patients seen. Try and pick cases which demonstrate one or more of the six competencies above.

- Linkage to the OOH competencies in Chapter 7 of the curriculum

 

The COGPED statement makes it very clear that it is the trainee's responsibility to present the ARCP panel with sufficient evidence to convince the panel that the appropriate competencies have been gained. Don't be too worried about whether their OOH sessions have been 4 or 6 hours long and but concern yourselves diligently with demonstration that the Chapter 7 competencies have been acquired. And remember that chapter 7 competencies can be acquired in a variety of settings in addition to OOH.

 

Satisfying the panels that OOH competencies have been acquired is one of the most frequent problems trainees encounter at ARCP time  and at the end of the training programme this is a high stakes issue - so please do not to take this issue lightly. And please if you have any doubts or queries, ask for clarification sooner rather than later.

 

 

Courses on the Acutely Ill

Yorkshire-Humber Deanery runs a regularly scheduled Care of the Acutely Ill course. If you attend one of these, you can count ONE of these as ONE of the sessions required for OOH.

 

 

 

Frequently Asked Questions

 

When Does OOH Happen?

The new General Medical Services contract (nGMS) has defined the normal working day for general practice to be between 08.00 and 18.30 on all weekdays except public holidays. Thus, OOH is defined as that work undertaken between 18.30-08.00 and all day at weekends and on public holidays. However, in GP training, OOH is also taken to mean the type and style of working that takes place in this time.

 

But I Don't Plan Doing OOH When I Qualify as a GP. So Why Do I Need to Do It? In fact most GPs in my Practice Don't Even Do It?

The opinion of the College is that GP StRs should continue to be trained in OOH work, as this remains a core part of the GP’s role. However, opinion doesn't mean anything without justification, so here goes:

 

1. Some of the skills and competencies needed for OOH care, for example those exhibited in undertaking telephone triage, also take place during the normal working day, and therefore is a good opportunity for more practise and consolidating learning

 

2. You cannot predict your future. Your circumstances might change where you might need extra income and thus engage in OOH. For that reason, isn't it better to have had some training than none?

 

What If I am Part-time? (Less Than Full-Time Trainee LTFTT)

Trainees who are working less than full time in a traditional GP post are not expected to do the same level of on call as a full timer. Their slice of the cake should be pro rata i.e. 60%.

 

How Is GP Training in OOH Structured?

Depending on what stage you are at in your training and how experienced you are, your clinical supervisor may either oversee your work in detail or take a step back and see how you get on.

 

Direct supervision [red]	the GP StR is supervised directly by the clinical supervisor and takes no clinical responsibility.
Close supervision [amber]	the GP StR consults independently but with the clinical  supervisor close at hand e.g. in the same building.
Remote supervision   [green]	the GP StR consults independently and remotely from the   clinical supervisor, who is available by telephone. An    example   of such a session would include a session ‘in the ‘car’ supervised by another GP ‘at base’.

 

 

What If I Need to Cancel an OOH Session?

Firstly, you shouldn't cancel unless it is absolutely necessary. If it is, you should try and swap that session with one of your colleagues; it is your responsibility to do this.

 

After making changes, YOU MUST INFORM:

1. the trainer you would have originally been on call with

2. the new trainer you will be on call with

3. the co-operative/deputising service, and

4. Dr. Nick Price & Sofya Loren (our administrator)

 

Who Organises the OOH Rota?

The Programme Director lead in Bradford is Nick Price.

 

Where Can I Find the OOH Rota?

Online of course! Go back to the main home page and look for the OOH link at the bottom left.

 

How Do I Know Whether the Clinical Supervisor I am Paired with Can Teach?

All clinical supervisors must be able to teach although they will not necessarily require the educational expertise required of GP trainers: The following will be considered fit:

 

• * GP trainers, GP associate directors and GP course organisers.
• * Holders of postgraduate certificates, diplomas or degrees in education.
• * Previous participants in the Deanery’s clinical supervisor training.
• * Doctors with significant teaching experience (postgraduate or undergraduate)  within the last five years, subject to the approval of the patch Associate GP Director.
•     
• For non-GP clinical supervisors:
• * Those recognised by their own profession as qualified to teach students of the level to which they will be teaching GP StRs.
• * Those who have completed a clinical supervisor course within the Deanery
• .

 

Am I Covered to Do OOH Sessions? (Indemnity and liability)

Trainees in general practice will be subject to the normal processes of clinical governance, GMC regulations and civil law.

 

Each doctor will carry their own professional insurance and medical indemnity organisations have indicated that a GP trainee’s standard membership will provide indemnity for work undertaken during OOH training.

 

In short... YES. But double check with your medical indemnity cover provider (usually MDU or MPS).