URGENT AND UNSCHEDULED CARE(OOH)

 GUIDANCE UPDATED NOVEMBER 19

GP Trainees will be required to demonstrate their capability to work in urgent and unscheduled care in order to obtain their Certificate of Completion of Training (CCT)

Rather than a set number of hours of training as previously this area will need to be developed and demonstrated throughout your whole training program – developing evidence whilst in both GP and hospital posts.

  • Though there is now no minimum number of hours required, it is expected that anything less than 48 hours in UUSC will not allow the trainee to demonstrate the UUSC capabilities and Clinical Experience Group coverage thoroughly.
  • The 48 hours for UUSC is for full time ST3, pro rata for ST1/2 and LTFT ST trainees.
  • Any unmet requirements from posts started or completed prior to August 2019 will expect to be completed as per the previous requirements of 72 hours per year.
  • Our local ARCP panel will still be looking at total number of hours done to be able to get an idea of experience gained and it is still expected that trainees will log number of hours done in their e-Portfolio and will need their UUSC supervisor to sign an UUSC sheet as done previously.
  • We do expect a lot of the innovative UUSC to be done mainly in ST1/2 as they are mainly observational and expect more face to face, telephone triage and visits to be done in ST3.
  • Examples of innovative UUSC include:

Ambulance or Police attachments

The South Central Ambulance Service sessions, on Saturdays in Bicester

On-call with duty Psychiatrists, Community Psychiatric Nurses and teams

OOH and Terminal Care Nursing services to include Macmillan services

Social Workers and Social Care Services

Seeing patients in places like detention centres and prisons

Community Midwives

Walk-in clinics etc.

Specific local provision e.g. Community Paediatric Admission Prevention Services, etc.

Urgent Care and Minor Injuries Centres

Rapid acute medical care services

  • UUSC also DOES NOT include urgent care done in-hours at GP practices. This is because work done in UUSC is normally unique in that you do not have access to notes, it is often done when GP Practices are closed in certain services and different computer systems are used.
  • You will need to provide evidence in your UUSC learning logs of how you feel you have demonstrated the 13 capabilities and covered the 8 Clinical Experience Groups. 
  • The ‘traffic light’ system has now been replaced. Instead, your Educational Supervisor is required to indicate when they feel you are ready to progress from full supervision to possible ‘remote’ supervision. This can be done through an educators’ note in the e-portfolio which can be shown to your supervising doctor. The aim is for an ST3 trainee to be working independently prior to CCT.

URGENT CARE PROVIDERS

The main providers of GP out of hours services in our area are Westcall and OxDocs.  Westcall covers our Berkshire practices and OxDocs covers Oxfordshire*.  You need to undertake an induction to work in Westcall and these are arranged for VTS trainees annually – usually in September of each year.

All GP out of hours sessions must be done under the supervision of a trained OOH educational supervisor and can therefore be limited in numbers.  We recommend you make contact as soon as possible with your OOH provider as it can be difficult to fit in all our your sessions if you arrange them late.

  • Contact email for booking shifts with South Central Ambulance Service:   Scheduling.Department@scas.nhs.uk
  • Contact email for booking  Oxfordshire out of hours shifts: ooh.st3oxford@gmail.com
  • Contact email for Oxfordshire out of hours (OxDocs) Karen Haycroft: karen.haycroft@oxfordhealth.nhs.uk
  • Contact email  for booking Westcall out of hours shifts (Berkshire): admin.westcall@nhs.net

*Oxfordshire practices (Goring, Wallingford, Henley or Sonning Common) are based with OxDocs, all of the other scheme practices are covered by Westcall.

EWTD

You will need make sure that your OOH work maintains compliance with the EWTD.  As such you may need to do a shorter surgery the day before and/or after your shift.  As you are paid an uplift to your salary for doing OOH you will need to “pay back” these hours to the practice at another time. To assist the practice make sure you inform them (trainer and practice manager) ASAP to allow this time off to be arranged.  EWTD stipulates that you have:

a minimum of 11-hours’ continuous rest in every 24-hour period

a minimum rest break of 20 minutes after every six hours worked

a minimum period of 24 hours’ continuous rest in each seven day period (or 48 hours in a 14 day period)

Trainee/ supervisor responsibilities with respect to safe OOH working:

COGPED has issued the following guidance regarding your responsibilities when undertaking OOH shifts:

‘GP registrars must be aware at all times of their level of clinical competence, and have professional responsibility for seeking advice and clinical supervision when required. It is the responsibility of the GP Registrar to seek appropriate help with the management of any case which has caused concern, and the GP Registrar should only proceed to take clinical responsibility having received satisfactory advice to cover all areas of concern. Should the GP Registrar not feel competent to take clinical responsibility, it is the responsibility of the OOH organisation and the clinical supervisor to make alternative arrangements for management of that particular patient.’ 

‘GP Registrars must be insured with a Medical Defence Organisation (a condition of training as a GP Registrar), which will provide indemnity in the event of a clinical error during the management of a patient.  The GP Registrar must liaise with the clinical supervisor at the start of each shift and is responsible for ascertaining how the working and supervisory arrangements of the shift will occur, and when and how the feedback will be arranged.’

The recording sheet for OOH shifts which needs to be signed by the supervising clinician covering you and scanned onto your eportfolio can be found through the link below:

OOH Resources:

Oxfordshire OOH induction information for registrars

Reading and Newbury VTS OOH Record Sheet 1

https://heeoe.hee.nhs.uk/general_practice/gp-trainees/urgent-and-unscheduled-care

https://www.rcgp.org.uk/training-exams/training/mrcgp-workplace-based-assessment-wpba/urgent-and-unscheduled-care.aspx