OOH notes

The 5 OOH Competencies

  1. Ability to manage common medical, surgical and psychiatric emergencies.
  2. Understanding the organisational aspects of NHS out of hours care (nationally & locally)
  3. The ability to make appropriate referral to hospitals and other professionals.
  4. The demonstration of communication and consultation skills required for out of hours care.
  5. Individual personal time and stress management.

The aim of doing Out Of Hours (OOH) work is for all GP trainees to gain additional experience in this particular setting.  You will get experience of both face-to-face care and telephone triage.  More specifically, it will help you to

  • Be involved in the management of acutely unwell patients in a primary care setting.
  • Understand how out of hours Primary Care service can be organised
  • Experience a range of consulting styles in an out of hours centre, on home visits and using the telephone.
  • Have feedback from being observed consulting.

 We’ve noticed that some 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.  An example of a reflective write up is provided below.  Also remember that you are paid to do Out of Hours – it is included in your salary!  

The Training Programme Director with lead responsibility for OOH is Nick Price.   Please contact him if you have any further queries:  nickprice62@gmail.com   Please read the section below on specific points for Bradford trainees.

FREQUENTLY ASKED QUESTIONS

ORGANISATIONAL FAQs

SETTING THE RECORD STRAIGHT (click to open me)

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. BUT you are paid a  significant uplift in your salary for on-call and so cannot opt out.  In fact, not engaging with OOH yet still being in receipt of a full salary which includes pay for OOH is a probity issue! You might also find it helpful to remember that the Yorkshire-Humber approach to OOH is an educational one rather than a punitive or service approach.  Yorkshire & Humber 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.

The General Medical Services contract (GMS) 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.  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. Therefore, trainees will do a MINIMUM of 18 sessions of OOH by the time they finish GP training.  A full-timer will usually do a 3 year GP rotation of which 18 months will be in GP posts.  As OOH is done in GP posts, this means that they will need to do 1 OOH session per month.

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’s the trainee’s responsibility to do the OOHs, do the right number of OOHs and write them up in the most reflective and educational way.   Please try to make the job of your Educational Supervisor and ARCP panel easy – they really do want to push you to get through but cannot do that if you don’t provide the right information or evidence!  As well as the number of sessions you’ve done, the Panel will expect evidence of the educational quality of your OOH experience – so make sure that each session is supported by a log entry clearly indicating what you’ve learned. Ideally you should make clear how this relates specifically to the OOH setting (as opposed to what you might have learned from the same case in a routine setting).  You can maximise the chances of your OOH experience being accepted if you write an extra OOH log entry which summarises the evidence in your EP supporting the ‘OOH competencies’ (e g the 4 points below). Your ES and the ARCP panel need to be convinced that you….

  • Can consult effectively on the telephone
  • Recognise and manage acute illness in the OOH setting
  • Refer acute illness appropriately in the OOH setting
  • Understand the organisational aspects of OOH care

THE SET-UP IN BRADFORD - when, where, rota, contacts

Who to contact

The Training Programme Director with lead responsibility for OOH in Bradford  is Nick Price. Our administrator is Sofya Loren.  Please contact Nick or Sofya if you have any queries or problems in relation to OOH.  And do this EARLY.

Where do sessions happen?

  1. If you are down for a face-to-face or telephone session with patients at the OOH centre, then it will be Eccleshill Hospital.   Eccleshill Hospital is opposite Ashcroft Surgery (where Weds Tutorials are held).    Address: Eccleshill Hospital, Newlands Way, Off Harrogate Rd, Eccleshill, Bradford, BD10 0EP    Phone:01274 623000.   Click here to see Eccleshill Hospital on a map.    Click on this link for more information: www.nhs.uk/services/hospitals/overview/defaultview.aspx?id=34416
  2. If you are down for a mobile session – i.e. where you are driven to patients’ homes in a car, then you will need to report to Westbourne Green Community Hospital.    You will meet your Clinical Supervisor, the driver and the car at Westbourne Green in the car park (so – particularly important to be on time).  Address: Westbourne Green Community Hospital 50 Heaton Rd, Bradford BD8 8RA  Phone:01274 322093.  Click here to see Westbourne Green on a map.   Click on this link for more information: www.nhs.uk/Services/hospitals/MapsAndDirections/DefaultView.aspx?id=88911  .  If the mobile car hasn’t arrived, please call 01484421806.
  3. Bradford Royal Infirmary’s Primary Care Centre (PCC) – based in the basement beside, but not actually in, A+E.  It will be clearly indicated if your session is here, but most sessions happen at (1) or (2).
  4. Telephone triage currently runs at LCD at Lexicon House in Leeds.  Contact rota@lcdwestyorks.nhs.uk
  5. Sessions are available in other areas of LCD e.g. Airedale – where there is often more capacity.

What time does OOH start?

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.   Your session can start anytime from 1830 onwards.

Where can I find the rota?

It’s under the navigation menu tab ‘Our Scheme & Us’.

Who does the rota?

The rota is produced by Sofya Loren scheme admin, but we are reviewing this process with a view that you will be able to book directly with LCD.

Please read these important bullet points

  • 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!).  You can only access SystmOne via a smartcard.  It is your  responsibility to ensure you have a smartcard which can take 2 weeks to set up.  You must therefore get one in good time BEFORE you do your OOH sessions.  If you already have a smartcard, please get it updated so you can use it during Out of Hours by emailing rota@lcdwestyorks.nhs.uk
  • Please take the equipment you usually use for home visits with you (drugs, note paper, prescription pads are provided by LCD).
  • You will all need to at least 6 sessions recorded by the end of month 4 of each post, pro-rata for part time).  Make sure that you record each session in your ePortfolio – giving times and describing cases / learning. Note – record the shorter sessions as 4 hours e.g. those labelled by LCD as 1830-2200 as 1830 – 2230 – including time for case discussion and writing up (Deanery criteria gets too confused with 3 ½ hour sessions).
  • You may need to arrange with your practice to finish in time to get to Eccleshill for the 1800hr weekday sessions. After a late (2300hr) finish you may need to arrange with the practice a later start to work the next day to meet EWTD rules.
  • This is a mandatory part of your training and is non negotiable.
  • As with any other part of your job, just not turning up is not an option.  This is a big probity issue – just like it is unacceptable to simply not turn up for a surgery one day.   If you cannot make it because you’re sick or you are running unavoidably late ring LCD on 01484 421 803

You will have the opportunity to observe supervising GPs consulting, for them to observe you and for you to see patients alone but with the supervising GP available for immediate advice. This can be a good opportunity to getting some DOPs signed off. If the supervising doctor is familiar with COT and willing to do it, these sessions can be a good opportunity to do this too, maybe even CbDs if it is quiet.

SOME PRACTICAL POINTS

  • Please take the equipment you usually use for home visits (drugs, note paper and prescription pads are provided by LCD).
  • Get your SystemOne smartcard updated so you can use it at LCD, by emailing rota@lcdwestyorks.nhs.uk
  • You will all need to record not less than 6 sessions recorded by the end of month 4 of each post, pro-rata for part time). 18 sessions is the MINIMUM by the end of training.
  • Record each session in your eportfolio – giving times and describing cases / learning. Note – record the shorter sessions as 4 hours e.g. those labelled by LCD as 1830-2200 as 1830 – 2230 – including time for case discussion and writing up (Deanery criteria gets too confused with 3 ½ hour sessions).
  • You will have the opportunity to observe supervising GPs consulting, for them to observe you and for you to see patients alone but with the supervising GP available for immediate advice.
  • You may need to arrange with your practice to finish in time to get to Eccleshill for the 1800hr weekday sessions. After a late (2300hr) finish you may need to arrange with the practice a later start to work the next day to meet EWTD rules.
  • This can be a good opportunity to getting some DOPs signed off.
  • This is a mandatory part of your training and is non negotiable.
  • As with any other part of your job, just not turning up is not an option, if you cannot make it because you’re sick or you are running unavoidably late ring LCD on 01484 421 803
  • We recommend contacting your clinical supervisor by text within 48 hours of the session to confirm that they will be available to supervise you (numbers on the rota) i.e. to help ensure you don’t turn up and find you cannot do the session.
  • And remember – part of your salary is for doing OOH.  So, not engaging with OOH and still getting your full salary can be a probity issue!

WHAT IF I FAIL TO TURN UP FOR MY OOH SESSION?

The Deanery considers that non-attendance by the GP trainee for a booked OOH session without good reason is a professional offence and views this as equivalent of failing to turn up for a booked surgery in their own practice. In such instances the OOH clinical supervisor should notify the trainees GP Trainer and the trainee must put an entry in the portfolio explaining the circumstances surrounding the event.

WHAT IF I NEED TO CANCEL MY 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 (tel: 01484 487272) , and
  4. Dr. Nick Price & Sofya Loren (our administrator)

WHAT IF I'M LATE FOR MY OOH SESSION?

Trainees must make every effort to inform their OOH providers and Clinical Supervisors if they are unable to attend or are running late and should ensure they have the relevant contact details.  The OOH provider will raise late arrivals of any GP trainee with their OOH Clinical Supervisor for that session. If such behaviour is continued the GP Trainer will be informed.

HOW MANY OOH SESSIONS DO I NEED TO DO IN A GP POST?

The bottom line is that you need to have done a total of 18 sessions of OOH by the end of your training.  Most rotations usually offer 18 months in hospital jobs and 18 months in GP jobs.   As OOH is done in GP, 18 sessions roughly equates to ONE OOH session per month in General Practice.

Each OOH session should be of around 4-6  hours duration.  Whether it is 4 or 6 hours doesn’t really matter; as long as you do 18 sessions by the end of your training.   We know that OOH sessions vary in duration from region to region; but it’s the number of sessions that matters not the number of hours.  However, that does not mean you can finish (say) a 6 hour shift early – you have to stay for the entire duration. So, if the OOH set up in Bradford is such that each session lasts 4 hours, you must stay for the entire duration and do 18 sessions in total.   If , for example, in Leeds each session lasts 6 hours, again you must stay for the entire session (i.e. 6 hours) and again, do 18 sessions in total.  If your sessions are less than 4 hours, please do more than 18 sessions to bring your number of hours up.  For example, if your sessions last 3 hours, you will need to do an extra 6 sessions to make the hours up to the minimum requirements.  Remember, this isn’t much compared to what trainees do in hospital posts (take Paeds for instance). Failure to complete the requisite number of sessions will lead to a face-to-face deanery ARCP panel review.  If you are a less than full-time trainee, they the number of sessions you engage in will need to be adjusted on a pro-rata basis.

And finally, don’t forget:  it’s not all about the numbers. The educational quality of the sessions count too. If an on-call session is very quiet and provides little education – it is UNLIKELY to count; you will need to do another session.

WHAT IF I AM PART-TIME? (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.  As most LFTTs will be working part-time on a 50% basis, the frequency of OOH sessions should be reduced proportionately – in this case, one OOH session every 2 months instead of every month.  However, by the end of training, they will STILL need to have done 18 sessions – it’s just that the length of time they have to do it will be longer.

WHAT IF I AM DOING AN EXTENSION TO GP TRAINING?

In terms of number of OOH sessions, you need to do 1 OOH session per MONTH of being in a GP post.   So, if you have been given an extension of 3 months, then you need to do 3 extra OOH sessions on top of the minimum 18.

DOES OOH PHONE TRIAGE COUNT?

Phone triage is acceptable for part of Out Of Hours experience providing there is an appropriate balance with face-to-face sessions.

DOES UNSCHEDULED CARE IN THE PRACTICE OR EXTENDED HOURS COUNT?

The simple answer is NO.  Being the duty doctor and doing on-call surgeries for the surgery does not count.  Doing telephone triage for the practice does not count.   It has to be ‘out of hours’ – that means, outside of practice hours.  Although Extended hours is generally outside of practice hours, it is not classed as OOH work because patients are booked in and are not ‘unscheduled’.  Trainees are to be encouraged to do some Extended Hours but this is not compulsory.  However, it is still good to make use of this experience and record a log of it in your ePortfolio to show some evidence for the ‘Care of the Acutely Ill’ curriculum heading.

WHAT IF I HAVEN'T DONE THE RIGHT NUMBER OF OOH SESSIONS BY THE TIME OF THE ARCP PANEL?

You should all try to get ALL your OOH sessions before the time your ARCP panel is due.   However, we understand that sometimes this can be organisationally difficult.

If you are an ST1 or ST2 trainee

Your ARCP panel outcome will be considered satisfactory PROVIDING

  1. You have done at least 4 sessions out of the usual 6 by the date of a panel AND
  2. That the outstanding session(s) is/are booked AND
  3. That there are no concerns have been expressed on OOH issues.

Be aware: a later probity check will be undertaken by the Training Programme and it will be considered a serious professional offence if, once signed off, a GP trainee failed to complete any such booked OOH sessions.

If you are an ST3 trainee

  • If you are an ST3 trainee, all OOH sessions must be completed by the date of the ARCP panel.

SO IT'S ALL ABOUT THE NUMBERS?

Partly, yes, but there is more to the story.   ARCP panels will also look at your OOH log entry to see if you have written something which satisfies them that you have provided evidence of acquiring the competencies specified in chapter 7 of the curriculum – Care   of the Acutely Ill.  Besides being a more meaningful assessment this recognises that OOH sessions   in different places provide different experience, caseload and mix.  We know that every now and then, your OOH session can be quiet (i.e. not many patients walk through the door).   If this is the case, your session will probably not count and you will have to do another more ‘fuller’ session.   Panels have been known to reject trainees who have completed the minimum 18 OOH sessions because some of those sessions had very few patients being seen.

So, the bottom line is:

  • YES, you need to do a minimum of 18 OOH sessions.
  • But also to write up your OOH log entry in a way that shows
    1. you have done sufficient number of sessions
    2. you have exposure to sufficient experience
    3. you have acquired the OOH competencies.
  • And to remember that your OOH session will be rejected if they feel you didn’t see that many patients.

PS As a reminder  The 5 OOH Competencies are..

  1. Ability to manage common medical, surgical and psychiatric emergencies.
  2. Understanding the organisational aspects of NHS out of hours care (nationally & locally)
  3. The ability to make appropriate referral to hospitals and other professionals.
  4. The demonstration of communication and consultation skills required for out of hours care.
  5. Individual personal time and stress management.

AM I COVERED TO DO OOH SESSIONS? (INDEMNITY & 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).

WHY DO I NEED TO DO IT IF I DON'T PLAN TO DO OOH WHEN I QUALIFY?

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?

EDUCATIONAL FAQs

THE BASICS (click to open me)

3 things you should know

  • Guidelines on OOH: 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.  Click here to see the rota now.
  • 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 on-call systems 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 out of necessity varied; this also means that one model as an answer does not fit all.  Don’t be surprised if what you are doing differs from a peer on another scheme.

Why do I have to do Out-Of-Hours?

In a nutshell, you have to engage in OOH so that before we sign you up as qualified GPs, we can be certain that you:

  1. Are able to manage common medical, surgical and psychiatric emergencies in the out-of-hours setting.
  2. Understand  the organisational aspects of NHS out of hours care.
  3. Are able to make appropriate referrals to hospitals and other professionals in the out-of-hours setting.
  4. Can demonstrate the communication skills required for out-of-hours care.
  5. Can manage your own individual personal time and stress.
  6. Are aware and can maintain your personal security and awareness as well as that of others.

But I don’t get much educational experience from Out-Of-Hours!

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.

In summary…

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.  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.  Encourage the OOH Clinical Supervisor to complete a feedback sheet (they’re meant to do this anyway) – perhaps in relation to the 6 competencies above. Make sure you share 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.

TYPES OF SESSIONS

OOH sessions may include an appropriate mixture of

  • OOH as provided by the local deanery approved provider,
  • ambulance sessions,
  • psychiatric service sessions,
  • social service sessions and so on.

Because the availability of traditional sessions will be different from scheme to scheme the scheme, guidance on what non-traditional services will be accepted should be included as a log entry in the e-P if there is a lack of normal GP OOH so that the ARCP panels can review what has been approved locally. The skills needed for OOH can be acquired to some extent in these other situations and so where there are for organisational reasons difficulties in completing the expected total of 76 hours it is important for the trainee to complete other evidence to demonstrate the competencies which would normally be acquired in the OOH setting.

A NOTE ABOUT EXTENDED HOURS – which is not OOH work!  Extended hours is not classed as OOH work. Trainees are to be encouraged to do some Extended Hours but this is not compulsory.

HOW WILL I BE SUPERVISED?

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 – the GP trainee is supervised directly by the  clinical supervisor and takes no clinical responsibility.
  • Close supervision – the GP trainee consults independently but with  the clinical  supervisor  close at hand e.g. in the same building.
  • Remote  supervision – the GP trainee 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’.

GETTING THE MOST OUT OF OOH SESSIONS

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.  Here are some quick tips on getting the most out of your OOH session.

The first thing your Educational Supervisor and ARCP panels will check is to see whether you have completed the contractual obligations for OOH (i.e. the numbers – at least 1 session per calendar month of a 4-6 hour session).  As a trainee, you need to plan and think about how you are going to fulfil your out of hours commitments during your post.    You may wish to discuss this with your trainer and/or Educational Supervisor.   Please do not leave this till the last minute – otherwise there will be little opportunity to complete a sufficient number of  sessions toward the end of your post and this will create problems when an ARCP panel  assesses your portfolio.  Plan and get your sessions booked!

The second thing your Educational Supervisor and ARCP panel will assess is the educational quality of your OOH experience.   This will be done in relation to the competencies relating to the skills needed for OOH care.  These are…

  1. Ability to manage common medical, surgical and psychiatric emergencies in the out of hours setting. (Clinical Management)
  2. Ability to make appropriate referrals to hospitals and other professionals in the out of hours setting. (Decision Making/IMT/Working with Colleagues)
  3. Demonstration of communication skills required for out of hours care – including telephone consulting skills (Communication Skills/Working with Colleagues)
  4. Understanding of the organisational aspects of NHS out of hours care. (NHS structure/Admin/IMT)
  5. Individual personal time and stress management. (Fitness to Practise)
  6. Maintenance of personal security and awareness and management of the security risks to others (Fitness to practise/Working with Colleagues)

You need to make sure that each session is supported by a log entry clearly indicating what you have learned.   Rather than just writing about anything in an unstructured way, how about writing in relation to one or more of these 6 areas?how is this learning that relates specifically to the OOH setting different from the same case in a routine setting?   Doing these two things will help you write up your session in the most educationally rewarding way.  If you find it difficult to relate your session to one or more of these 6 competencies, speak to your OOH Clinical Supervisor.   Together, you in relation to these 6 areas.  Later on, share this 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.

The third thing that your ES and ARCP panel will check is the type of OOH sessions you have done.  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.

The fourth thing that your ES and ARCP panel will check is the busy’ness of your OOH session.  An OOH session where you’ve only seen three patients all evening is more likely to be less educationally rewarding than one of 10-15.  Therefore, it isn’t just about the numbers –  6 sessions of 6 hours each with an average of 3 patients per session does not look good in terms of providing enough educational experience.   Therefore, 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 OOH competencies you might need to i) pick the busier sessions, ii) do  more sessions than those specified in form B or iii) do 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.

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.  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.

To read more about Out Of Hours, click here.

WHAT IF I DIDN'T SEE THAT MANY PATIENTS IN MY OOH SESSION?

As we said above, it doesn’t look good if you only saw 2 patients during an OOH session.   The worry is that you may not be getting adequate exposure.  Therefore, you may need to do additional sessions to demonstrate adequate exposure.  You do need to do a minimum of 18 OOH sessions by the end of ST3, but if those OOH sessions are all quiet – then there is little evidence to give you an satisfactory grade  If you end up having a quiet time during OOH, please think – how can you make the session more educationally useful?  For instance, how about discussing the structure and organisation of OOH with your Clinical Supervisor?  How about sitting in with reception staff and seeing how they field calls?  How about fielding some calls yourself?  We hope you get the idea.  Remember, panels are assessing what’s in the e-Portfolio (i.e. the content), and not just the number of sessions done.

ADVICE ON WRITING AN OOH LOG ENTRY

These are the 6 generic competencies that you are supposed to be learning or performing during OOH sessions:

  1. Ability to manage common medical, surgical and psychiatric emergencies in the out of hours setting. (Clinical Management)
  2. Ability to make appropriate referrals to hospitals and other professionals in the out of hours setting. (Decision Making/IMT/Working with Colleagues)
  3. Demonstration of communication skills required for out of hours care – including telephone consulting skills (Communication Skills/Working with Colleagues)
  4. Understanding of the organisational aspects of NHS out of hours care. (NHS structure/Admin/IMT)
  5. Individual personal time and stress management. (Fitness to Practise)
  6. Maintenance of personal security and awareness and management of the security risks to others (Fitness to practise/Working with Colleagues)

Therefore, when writing up your entries, it is important to write about one or more of these specific aspects.   Most of your OOH log entries will probably be about 1, 3 and 4.   But don’t forget about 2, 5 and 6 (which often get overlooked!).

The following format may help you…

    • Date:  July 21st 2014
    • Supervisor: Dr A Dunbar
    • Type of OOH session:  face to face consultations
    • Venue: Airedale GPEC
    • Time: 19:00 – 23:00 (5 hours)
    • Number of patients seen: 15

What did you learn?

Type of patients seen:

  • Several minor respiratory infections – children and adult
  • Acute back pain
  • Probable depression
  • Drug abuser seeking medication
  • New migraine
  • Emergency contraception.

Interesting cases and learning points

  • Acute back pain – Description and reflection
  • Probable depression – Description and reflection
  • Methadone user – Description and reflection
  • Migraine diagnosis – description and reflection

What will you do differently…?

What further learning needs did you identify?

How will you address these?

These should be completed in the same way as all other portfolio entries.

Naturally each entry should be linked to the ‘care of the acutely ill’ curriculum statement and any other parts of the curriculum that the session provided significant exposure to.

EXAMPLE OF AN OOH REFLECTIVE LEARNING LOG ENTRY (click to open me and then click on the left hand tabs)

EXAMPLE OF AN OOH REFLECTIVE LOG ENTRY

PLEASE CLICK THE HEADERS BELOW TO SEE MORE

  • Venue: Bradford OOH
  • Date: July 21st
  • Time: 19:00 - 23:00 5 hours
  • Supervisor: Dr Ashraf Khan
  • Type of session: face to face consultations
  • Number of patients seen: 7

1) LRTI – 64 yr old Asian lady with COPD and CKD seen with daughter interpreting. Presented with symptoms and signs of LRTI, admitted to BRI due to tachypnoea, tachycardia, and dehydration. 2) Abdo pain – 18 yr old girl with Down’s syndrome, seen with parents, with crampy abdo pain and 3 wks alternating constipation and diarrhoea. 3) Threatened abortion – 19 yr old lady with partner with threatenred abortion at 6 wks. Scan arranged for 1 week later, patient unhappy with wait. 4) 2yr old, wheezy and pyrexial from URTI.  Seen with separated parents, much confusion between them abot which inhalers were prescribed. Desperate for something to be done to help child sleep. Advised child was well at present (wheeze and pyrexia settled), and needed to see own GP for further clarification of long term management plan.  Several minor respiratory infections – children and adult,  acute back pain,   probable depression, drug abuser seeking medication, new migraine, emergency   contraception. 5) Acute back pain – 24y old with acute low back pain for 3d, not settling.  No alarm features.  Analgesia and mobility advice given.  see own GP 6) Probable depression – 33y old low mood, going on for months but getting worse.   no suicidal ideation.   empthathised, advised to see own GP. 7) Migraine diagnosis – 45 y old with typical migrainous headache (hemicrania, photophobia, aura etc) – given im sumotryptan

Communication – I found the case of the girl with Down’s syndrome interesting as I presumed I was going to have immense communication and cognitive difficulties with her. I was also anxious not to miss a serious problem – perhaps she would not be able to accurately present her problems. But this couldn’t be further from the truth! The patient was charming and cooperative. She spoke quite a few words to me and we didn’t really need much input from her parents (although they did contribute, of course).

1) I must not presume that someone with learning disabilities means the consultation will be more difficult (person centred care and hence practising ethically) 2) I built rapport in this particular case by introducing myself and showing interest in her comments about cartoons and toys. This helped the consultation to ‘flow’. (communication skills) 3) Of course, there were other things that made this consultation ‘flow’ – such as keeping questions and language as simple as possible. (communication skills, data gathering) 4) It’s important to engage other people present in the consultation (in this case, the parents) not only to triangulate the information recieved (data gathering & interpretation), but to get a fuller picture (practising holistically) and make them feel involved. 5) During the examination I was conscious that it was important to keep things as comfortable as possible for her while still completing the necessary exam as I did not want to lose her trust and possibly make her frightened of doctors in the future. In fact she expressed no pain and giggled throughout her abdo exam.

In the end, I was relieved to exclude an acute abdomen and was pleased that the consultation went well with the invaluable input of the patient’s parents. I think she had constipation. She hadn’t been to the toilet for several days, her motions prior to that were round pellet like and the pain was crampy and colicky in nature. There were no alarm features and the history was fairly acute (making diagnoses/decisions). I gave her some movicol and suggest she be reviewed by her GP in 2 weeks if no better. (clinical management)

Here are the competencies the Clinical Supervisor awarded…

  1. Communication Skills
  2. Data gathering & interpretation
  3. Practising holistically
  4. Making diagnoses/decisions
  5. Clinical management

Notice how the trainee in this excellent write up indicates (in parentheses) which clinical competencies her statements and learning points relate to.   For a professional competency to be awarded, you must show some reflection on that particular competency resulting in some sort of action to be maintained or pursued in the future.

COURSE ON THE ACUTELY ILL

Yorkshire-Humber Deanery runs a regularly scheduled Care of the Acutely Ill course. See the Y&H Deanery website for more details.

CRITERIA FOR QUALIFYING AS A OOH CLINICAL SUPERVISOR

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

  • GP Trainers,  GP Associate Directors and GP Programme Directors
  • Holders of postgraduate  certificates, diplomas or degrees in education.
  • GPs who have been on the Deanery’s Clinical Supervisor’s training course.
  • Doctors with  significant teaching experience (postgraduate or undergraduate)  within the last five years, subject to the  approval of the patch Associate GP Director.
  • 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’s training course with the Deanery