Urgent Unscheduled Care (UUSC)

As a GP, you will need to be capable of handling urgent and emergency presentations who present in an unscheduled manner. By unscheduled, we are referring to patients who want to see a doctor acutely (i.e. they did not book into a routine scheduled appointment). There are a variety of settings in which patients present urgently in an UNSCHEDULED manner.

• Duty Doctor for the surgery (i.e. on-call surgeries)
• Out of Hours GP Centres (Run locally by IC24)
• GP centre attached to A&E departments
• GP Extended hours work where the appointments are for acute unscheduled problems and not routine.
• Other primary care emergency/acute services delivered within a secondary care or community care provider.

So, don’t just rely on one of these places for gathering evidence for your engagement in Urgent Unscheduled Care. Your experience (and evidence) should be from a mixture of working with these services.

GP trainees must ensure they have

1. completed all due employment processes prior to undertaking both observational and clinical sessions
2. had an enhanced DBS check
3. met occupational health requirements and
4. undertaken required safeguarding training.

The guidance on urgent and unscheduled care (UUSC – formerly OOH) training requirements for GP trainees was updated in 2019. The new guidance moves away from ‘counting hours’ of UUSC work completed. Instead it puts the responsibility onto the trainee to ensure full and comprehensive learning has been undertaken. It asks them to demonstrate this against six UUSC statements. Simply counting hours may not correlate with the actual clinical experience and subsequent knowledge and competencies that are demonstrated.

All trainees will still have to complete OOH training. They still need to use the OOH setting to sign off appropriate competencies and all trainees must have the opportunity to experience delivery of OOH primary care in settings away from their usual place of practice.

Whilst there is no stipulated minimum number of hours worked outside the practice setting, it is thought it will take most trainees at least 48 hours in ST3 to achieve competence in all aspects of UUSC. In all cases a sign off as “competent” will need to be justified by the evidence provided. We would suggest trainees start to familiarise themselves with the breadth of UUSC in their area during their GP placements in ST1 or 2. This could include observation of others or experience working in urgent care providers

If you do any shifts at a local Out of Hours centre – this needs to come off the 40 hours maximum working time per week. Your practice will not know when you are doing Out of Hours. So, when you have your dates, please tell your Practice Manager early so that he or she can tweak your rota to ensure your average week working time remains 40 hours and no more. Telling them in advance helps them to do this without disrupting the service provision to patients from their practice.

The DOOHL group considers time observing colleagues and teams who support GPs in offering UUSC (e.g. the crisis team, paramedics) a valuable element of training, particularly for trainees who feel they haven’t covered these areas in other aspects of their training. Observation, including sitting in with a GP and watching them consult, is considered educational and therefore counts towards this element of their working week.

The vast majority of UUSC is expected to still be undertaken via our OOH provider, IC24. It would be expected that to achieve competence trainees will have experienced working in all shift types including face to face (base shifts), telephone triage and visits.

Additional opportunities exist:

• “In-hours” practice
  • Duty doctor experience
  • Extended access appointments during evenings/weekends at your training practice
    

• “Out of Hours” practice
  • Regional ambulance services
  • Local psychiatric “crisis teams”
    
• Secondary care rotations
  • Emergency medicine, Paediatrics and Psychiatry

1. Ability to manage common medical, surgical and psychiatric emergencies
2. Understanding the organisational aspects of NHS out of hours care, nationally and at local level
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
6. Maintenance of personal security, and awareness and management of security risks to others

An UUSC log sheet should be completed by a trainee at the end of each UUSC shift. This form should then be signed by the UUSC clinical supervisor. The completed form should then ideally be uploaded to the eportfolio as an OOH log entry.

Separately, you should keep an UUSC competency record and update this after each shift. Your educational supervisor will review the competency record, alongside discussion with the trainee regarding their experience in UUSC settings. Once a competency record is complete it should be uploaded to the eportfolio and linked to areflective learning log entry under the OOH heading so that it is easily visible by the ARCP panel

In circumstances where NHS indemnity is provided GP trainees should recognise that additional personal indemnity is strongly advised. There are other professional activities which may not be covered by the NHS or Crown Indemnity. Therefore, you are strongly advised to maintain membership of a recognised medical defence organisation or insurer for these purposes. It will give you that extra peace of mind should you be involved in a medico-legal case. Medical indemnity organisations usually indicate that a GP trainee standard membership will provide cover for unscheduled and urgent work, but this should be confirmed by GP trainees with their individual provider.