Out of Hours Training
Experience in Out-of-Hours (OOH) care and the Care of the Acutely Ill Chapter of the GP curriculum.
Introduction
This guidance is primarily written for General Practice Specialty training Registrars (GPStRs), but also Clinical and Educational Supervisors and Programme Directors in the Yorkshire and the Humber Deanery and is intended to provide overarching guidance on how to interpret current national guidance on Out-of-hours training. It should however be stressed that as circumstances differ in the way OOH care is arranged between individual training programmes across the Deanery, trainees must follow the requirements outlined in their respective programmes. The arrangements in each programme should fit with the guidance here.
Competency in OOH Care
The College describes clearly in its Chapter on Care of the Acutely Ill in the Curriculum the competencies the trainee should be looking to demonstrate in this area and these are outlined below. Please refer to the linked Attachment ‘Care of the Acutely Ill’ on this page for further details
- Ability to manage common medical, surgical and psychiatric emergencies in the out-of-hours setting.
- Understanding of the organisational aspects of NHS out of hours care.
- Ability to make appropriate referrals to hospitals and other professionals in the out-of-hours setting.
- Demonstration of communication skills required for out-of-hours care.
- Individual personal time and stress management.
- Maintenance of personal security and awareness and management of the security risks to others
At the ARCP panel, trainees will be assessed whether they have had sufficient experience in any GP post during the year to develop the above (see below for guidance) and need to demonstrate in their entries how they have made progress over the previous year with respect to these competencies.
Numbers and Length of Sessions.
COGPED guidance on OOH (2009) indicates a MIMIMUM benchmark of one 4-6 hour session per month in any GP post. Therefore, in some training programmes, trainees could have as little as 24 hours experience over six months depending on the length of OOH sessions locally. The Deanery considers 24 hours to be the bare minimum required to demonstrate experience and learning and stresses that the minimum of SIX SESSIONS are necessary to provide appropriate exposure and learning.
It is recognised that some OOH sessions provide more experience than others and therefore it is considered the responsibility of the trainee to provide clear evidence of the learning they have derived from their OOH sessions on their portfolio – see appendix 1 below.
The LENGTH of any session is therefore ultimately defined by the local circumstances of OOH provision and the length of the Clinical Supervisors session. Each session should include sufficient time for debrief and the opportunity to record the session on the e-portfolio. The maximum amount of hours allocated to any single session should be 6 hours.
If the GPStR is in an integrated training post based in General Practice they should undertake the same number of sessions as those in traditional General Practice placements. Less than full-time trainees should undertake the same number of sessions as their full time colleagues but over a longer timeframe.
Types and Balance of Sessions.
Depending on local circumstances, some programmes have developed alternative experiences to the traditional OOH session in order to further enhance the breadth of experience available to trainees (e.g. experience with a telephone triage service, the ambulance service or crisis team) Guidance on the appropriate balance of these sessions should come from local programmes, as they are best placed to have knowledge of the OOH arrangements in their area. This local guidance must ensure that trainees have the appropriate experience to develop the competencies above and trainees must abide by any such local programme guidance with respect to the balance of their sessions.
Out of hours training sessions cannot be counted as a session of out of hours care. Neither can telephone triage, or treatment of walk-in patients, in the training practice during the working week count as a session.