As part of your GP training, you need to show that you are capable of providing urgent and unscheduled care (UUC).
GP surgeries are open for routine matters and emergency cover between 8 am and 6.30 pm Monday to Friday. OOH is defined as emergency cover outside of this time. (‘Extended hours’ bookable surgeries do NOT count as OOH.) See the attached document for the deanery guide to OOH.
What do I have to do?
Your contracted GP job plan includes four hours of OOH per month (48 hours per year). For individuals training less than full time this will be pro-rata.
For ARCP there is no mandatory number of hours – the focus should be on demonstrating capability in urgent and unscheduled care and to do this the four hours above is recommended.
Out of hours experience is gained by undertaking shifts at increasing levels of supervision as detailed in the OOH policy below.
In order to demonstrate your capabilities you need to have completed your OOH shifts before the date of final e-Portfolio completion for ARCP, ie: 2 months before the end of ST3 or one month before the end of ST1/2.
An UUC feedback form needs to be completed by the trainee with the OOH supervisor at the end of each shift. This should then be uploaded to a learning log entry in your e-portfolio. So it is easy to find, we recommend you enter ‘OOH session’ in your learning log title and the number of hours of the shift and the total number of hours you have completed in OOH.
Your work schedule within your practice will take into account the OOH requirement. The scheduling of out of hours work must also remain compliant with the average 40 hour weekly total and you must also ensure a safe working pattern in accordance with the terms and conditions and scheduling requirements of your contract.
All work done outside of the training practice must have appropriate clinical supervision according to the trainee’s current experience and capability:
Observed Sessions – trainee observes health or social care professional providing no clinical care themselves (counts as trainee educational time; no clinical supervision required)
Direct Supervision – trainee consults with approved OOH clinical supervisor observing and holding final clinical responsibility (counts as trainee clinical time).
Near Supervision – OOH clinical supervisor works in same location and is readily available for discussion and debriefing or to review the patient themselves if necessary (counts as trainee clinical time).
Remote Supervision – OOH clinical supervisor is in a different location from trainee but available at all times for advice over the phone (e.g. trainer in base with trainee on home visit). The trainee must have completed some near supervision sessions and have agreed with their ES that they can work safely under remote supervision. (counts as trainee clinical time).
All levels of supervision (especially 2-4) can contribute to helping a trainee demonstrate capabilities.
Trainees need to discuss their supervision level with their ES/CS – this may be different for different types of consultation – For example: telephone triage as opposed to face to face consulting. They should state their agreed supervision level at booking, and then confirm this level is appropriate with their OOH clinical supervisor at the start of each shift. If there is any discrepancy the highest level of supervision requested should be used initially until both parties feel ready to progress.
We expect observational sessions to only happen in ST1/2 (as well as direct or near supervision if sessions available), and a very quick progression in ST3 to near supervision if this hasn’t already happened. There is no requirement to have done any sessions with remote supervision.
Who provides OOH services?
Oxford Health co-ordinates the OOH across Oxfordshire
Where does OOH care take place?
The Out of Hours Base Centres are located at:
– Horton Hospital, Oxford Road, Banbury, OX16 9AL.
– Bicester Community Hospital, Kings End, Bicester, OX26 6DU.
– Witney Community Hospital, OX28 6JJ.
Patients contact the OOH service by phone. Phone calls are handled by a call centre and then triaged by the clinical OOH staff working at the base centres. They will arrange for a visit by doctors or paramedics, or an appointment at the base centre with a doctor or emergency nurse practitioner.
There needs to be a balance of sessions undertaken, not all your out of hours sessions should be at one location.
In ST1/2 but NOT in ST3 trainees can also use up to 18 hours of out of hours time to experience non-GP services out of hours for example:
– The ambulance service
– The police
– On-call psychiatry
– Community psychiatric teams
– District nurses and palliative care nurses
– Social workers and social care services
– Community midwives
– Walk in clinics
How do I book my OOH shifts?
Contact the OOH shift co-ordinator:
Shifts are only bookable a few weeks in advance, as GPs often change their shifts around and it is important that a GP registrar is booked with an appropriate team member.
If you have a particular GP you want to work with who you know is doing a particular shift, that is fine, but the shift MUST be booked via the OOH service or there may be insufficient rooms.
There is also the option to organise observed OOH sessions with another health professional such as a paramedic or emergency nurse practitioner. As with other OOH sessions it is essential that your log entry demonstrates learning in urgent and unscheduled care.
How long are OOH shifts?
This is variable but usually at least 4 hours.
How do I record my OOH experience?
At the end of each session complete an UUC session record form together with the OOH clinical supervisor for the session. Then upload this to your e-portfolio. So it is easy to find, we recommend you enter ‘OOH session’ in your learning log title and the number of hours of the shift and the total number of hours you have completed in OOH.
A summary of all OOHs sessions worked (showing a trainee has completed a mixture of triage, home visits and face to face consulting) will enable you to demonstrate your capabilities.
You must show the signed completed forms to your ES/CS in order to claim time off in lieu (TOIL).
Trainees can also demonstrate learning from OOH sessions as ‘Clinical Case Reviews‘ and WPBA (For COTs & CATs to count for ARCP the supervisor completing them must be a deanery approved educational supervisor).
How am I signed off as ‘competent’ for OOH at the end of my training?
When your e-Portfolio is signed off by your educational supervisor at the end of year 3, they will need to confirm that there is ‘evidence of OOH competency’. Your ES will only be able to do this if you have added the evidence to your e-portfolio.
HEE Thames Valley GP school guide for working out of hours: