Separate out of hours training for GP speciality trainees has been necessary since the change of the GP contract in 2004. The increasing diversity of type of care provided by GPs in the urgent and unscheduled care setting dictates the need for all GP trainees to develop skills and competencies in this area. It is likely in the future that an increasing range of care will be provided out of normal surgery hours with different models of care including Urgent Care Centres, Walk In Centres, 7 to 7 services provided across a range of practices.
COGPED has re-issued a statement confirming the need for separate out of hours training for GP trainees.Six Out Of Hours competencies have been identified, and there are detailed descriptors of these competencies described here.
In order to complete Out of Hours training, GP trainees must both complete the time requirement (six hours per month full time equivalent), and demonstrate evidence to support that they have achieved the six out of hours competencies. The Educational Supervisor will sign off out of hours competence at the last Educational Supervision only if the trainee has provided both evidence of completing the hours required, and has demonstrated the six competencies. Health Education East of England recommends a tutorial discussion for at least an hour to discuss the signing off of Out of Hours training, prior to the final Educational Supervision.
Trainees need to ensure they undertake a range of type of out of hours sessions, that should include telephone triage and assessment, face to face consultations, and home visits. Towards the end of training the trainees should ensure that they have done both weekend day shifts and weekday evening shifts, and have experienced working with a range of staff. For the purposes of completing out of hours training trainees it is recommended that trainees spend up to a maximum 10% of the training time in induction training, or in a 111 service, or with an out of hours district nurse. It is important for trainees to understand that when they are observing practitioners in another service they should not take responsibility for treating patients, as they may not be indemnified to act in this capacity without the supervision of an approved supervisor. Up to 20% of training could also be completed in a training approved non-standard out of hours service such as a walk in centre, or an innovative seven day working solution in the out of hours period, but at least 70% should be with a commissioned and training approved out of hours GP service. The rationale for this breakdown is to allow sufficient time for a trainee to develop and consolidate the out of hours competencies. Trainees should always be supervised by an approved OOH Clinical Supervisor, Associate Trainer or Trainer when providing patient care Out of Hours. This person would normally be a registered GP. If the OOH Clinical Supervisor is not a GP, there should always be a GP available in the OOH period to support the Supervisor.
Trainees should demonstrate competency in the provision of OOH care. The overall responsibility for assessment of competency is with the Educational Supervisor, but trainees have a duty to keep the record of their experience, reflection and feedback in the competency domains; and to collect evidence in eportfolio to support demonstration of the competencies.
The six generic competencies , embedded within the RCGP Curriculum Statement on ‘Care of acutely ill people’, are defined as the:
- Individual personal Time and stress management.
2. Maintenance of personal Security and awareness and management of the security risks to others
3. Demonstration of Communication skills required for out-of-hours care.
4. Understanding of the Organisational aspects of NHS out of hours care.
5. Ability to make appropriate Referrals to hospitals and other professionals in the out-of-hours setting.
6. Ability to manage common medical, surgical and psychiatric Emergencies in the out-of-hours setting.
RED Session (Direct Supervision) First stage (months 1-2 of GP posts – first 1-2 centre/base shifts, first 1-2 visit shifts) GP Trainer (GPT) or Clinical Supervisor works an OOH session with the GP trainee but the GPT/CS sees patients and trainee remains supernumerary in an observation role, or learning to use the cinical system during the joint consultation. The trainee should progressively take personal clinical responsibility for a caseload, initially under direct supervision of the GPT/CS, (as in a Joint Surgery format). The trainee may then, with agreement of their GPT/CS, independently see and report back after each consultation to agree a management plan.
AMBER session (Close Supervision) Second stage (months 3-5) GP Trainer or Clinical Supervisor and trainee both attend sessions and both see patients. The trainee should be able to manage most cases without direct reporting to their supervisor about every case, but the supervisor is available throughout, and will debrief at the end.
GREEN sessions (Remote Supervision) Third stage (months 6-18) Please note all OOH must be completed by the final ARCP. The trainee works the OoH session with the GPT/CS being directly contactable, elsewhere on-site, at home or in a `roving’ car.
The lead provider of OOH services in SWL as of 31.05.22 will be Practice Plus Group.
GPST’s best point of contact is: londonrotateam londonrotateam@practiceplusgroup.com
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