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 however paid a VERY 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.

 

 

 

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?

 

 

 

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.

 

 

 

How Many OOH Sessions Do I Need to Do in a GP Post?

 

* The indicative benchmark is 6 hours every month for a full timer, adjusted in other settings on a pro rata basis. (This equates to 72 hours per year iin general practice.)

 

* It's not as simple as one session every month because in Bradford, for example, our sessions do not last 6 hours, and hence you need to more. In Bradford: a full time trainee would need to do around 2 per month (one session usually lasts 3 hours).

 

* Remember, this isn't much if you reflect back and think of how many times you had to do on call in your hospital posts (Paeds for iinstance)

 

Failure to complete the requisite number of sessions will lead to a face-to-face deanery ARCP panel review.

 

 

 

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’.

 

 

 

Have You Got Any Advice on How to Approach OOH to Maximise Learning?

 

I am glad you asked about that. 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.

 

So, how can you maximise the learning potential from an OOH? Here's how:

 

* Download and print off a copy of the OOH work booklet from the downloads section above.

 

* Download and print off the "OOH Sessions - How to Maximise Learning" (again, in downloads section above) and hand this over to your OOH clinical supervisor on the day (to ensure they know what they are meant to be doing)

 

* Encourage the OOH clinical supervisor to complete a session feedback sheet (they're meant to do this anyway). 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.

 

* Don't forget to record each OOH session in the e-portfolio.  The portfolio necessitates that each entry must be tagged before filing against, at least, one curriculum statement heading.  Normally, in the case of an OOH session, this would be curriculum statement 7: Care of Acutely Ill People.  The ‘OOH session’ learning log entry in the e-portfolio will prompt the GP StR with a number of set entry fields.

 

* All OOH sessions entered into the e-portfolio must be ‘shared’ with the educational supervisor.  In particular circumstances, the supervisor may choose to ‘validate’ some of these as contributing to workplace-based assessment.  In this case, the entry will also be tagged against one of the 12 professional competency areas.

 

* You'll find a whole host of interesting resources you may wish to look at before, during or after your OOH session in our "online resources" section on the home page. Click on it, then select "07. CARE OF ACUTELY ILL PEOPLE AND OOH".

 

Remember, failure to complete the requisite number of sessions will lead to a face-to-face deanery ARCP panel review.

 

 

 

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 & Vicky Baxter (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).