From August 2019 GP "Out of Hours" training will be changing to "Urgent and Unscheduled Care".
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 capability will need to be developed and demonstrated throughout your whole training programme - developing evidence whilst in both GP and hospital posts and evidence this as in the flowchart below:
This page aims to help trainees and educators to understand and adapt to the new process.
This can be accessed in Health Education England (HEE) approved centres working with HEE approved Clinical Supervisors, including extended access hubs within training practices. It is also possible to develop capability within hours during “duty days” in training practices and in the hospital during jobs such as A&E, psychiatry, acute medical units and whilst on call in paediatrics.
Most training has to be during GP attachments, and it is likely that the bulk of this will be during ST3. Relevant experience may be accrued during the hospital posts listed above. Observational sessions, in which the trainee attends relevant courses or observes other health professionals, without undertaking any clinical responsibility for patients, can be undertaken as part of the normal weekly protected educational sessions at any time throughout training. This is useful within ST1 and ST2 to demonstrate progression of competence.
The learner must not embark on this training during sick leave or whilst Out of Programme (OOP). It is possible to undertake observational or direct supervision sessions on Keeping in Touch Days during maternity leave provided this has been agreed with the Indemnity provider, ES and TPD. Near and remote supervision sessions must not be undertaken.
Any session that is worked outside of the normal practice hours (excluding study leave for relevant courses) must be compensated by time off in lieu and should be granted by your training practice. This time may be given back at any time during and does not have to be the same week as that which it was worked. Observational sessions within the training practice, approved out of hours settings, extended access hubs or urgent care centres should be taken from the weekly self-directed study time.
In the unlikely event that practices are not providing time off in lieu you should initially speak to your educational supervisor. If this does not resolve the issue, then your training programme director needs to be informed.
The lead employer has agreed that the new requirements will not affect the pay of GP trainees, despite them working fewer anti-social hours than in previous years.
This should only be HEE approved supervisors. However, observational sessions may be provided by a named supervisor in the organisation who may not be HEE approved.
There are six capabilities that need to be demonstrated by your pre-CCT ARCP.
a) Ability to manage common medical, surgical and psychiatric emergencies
b) Understanding the organisational aspects of NHS out of hours care, nationally and at local level
c) The ability to make appropriate referral to hospitals and other professionals
d) The demonstration of communication and consultation skills required for out of hours care
e) Individual personal time and stress management
f) Maintenance of personal security, and awareness and management of security risks to others
Use the Health Education East of England (HEEoE) GP School “Urgent and Unscheduled Care Observational Session Record”. The completed form should be signed by the clinical supervisor and then discussed and signed by the educational supervisor. You are strongly recommended to upload this onto the e-portfolio as it will provide evidence for your educational supervisor as to how you are progressing. Additionally, it is vital to document relevant cases seen when working in urgent and unscheduled care that reflect the required capabilities.
Capability will need to be demonstrated across a range of environments and throughout your training with an assessment of this at the end of each ST year and twice during ST3. The RCGP has suggested that the majority of the evidence should come from reflective case logs, but also WPBA. The Urgent and Unscheduled Care Session Observation Record may be uploaded as further evidence, but is not essential.
Some of you will already have undertaken out of hours training in previous years. This will count towards your overall capability assessment, but will need to be added to as you progress through your training.
Prior to each end of year ESR (and mid-point ESR if in ST3) you will need to complete the Urgent and Unscheduled Care Evidence of Capability Document. This document highlights where the evidence of capability is within your e-portfolio so that your educational supervisor may make a judgment on your progress.
Ultimately, it will be your responsibility to demonstrate your capability to your educational supervisor.
Developing capability is a continuous process throughout the three years of GP training and there will need to be evidence of progression at each annual review of competence (ARCP) panel. Capability may be evidenced from a variety of sources but in no circumstances will it include fewer than (and generally will far exceed) 48 hours of sessions worked in traditional out of hours settings during the ST3 phase.
It is very unlikely that this would achieve the capabilities by itself. There is an expectation that you can consult in an environment where full access to clinical records is unavailable. The capabilities do not relate to the management of routine care. It is anticipated that at least 48 hours will be undertaken in a traditional out of hours setting with additional experience within urgent care centres and extended access hubs providing additional evidence of capability.
You are encouraged to arrange CBDs, COTs, Audio COTs and CEPS as these will provide evidence of your capability. However, they need to be carried out by experienced HEE approved Clinical Supervisors who are well versed with the assessments.
Clinical Supervisor – Identifies capability and indicates this on the Urgent and Unscheduled Care Observational Session Record
Educational Supervisor – Confirms the assessment of the clinical supervisor using the Urgent and Unscheduled Care Observational Session Record and agrees further developmental needs with the trainee. At the end of year ESR assesses whether the “Urgent and Unscheduled Care Evidence of Capability” form demonstrates satisfactory development.
ARCP panels – Utilises the assessment by the educational supervisor as evidence for the panel’s recommendation regarding progress.
You should be reviewing this regularly with your ES. The “Urgent and Unscheduled Care Observational Session Record” should act as a trigger for a professional conversation with your ES, who should assess the evidence collated to that point and suggest further developmental needs that should be recorded as a PDP entry.
Use the HEEoE GP School “Urgent and Unscheduled Care Evidence of Capability” form and upload this using the same title to the e-portfolio. This form may be used to specify all the evidence within your e-portfolio that you feel is relevant including both log entries and WPBA.
You should have completed BLS & AED training. The BLS training is valid for 12 months and ALS training certificate is valid for 3 years, but the training should have taken place during GP training. The certificates on your e-Portfolio should be valid at the time of your CCT and attached to a shared log entry so that they are visible to your educational supervisor and the ARCP panel.